Utilization Management Nurse Specialist

At nTech Workforce, we specialize in providing comprehensive staffing and recruiting solutions tailored to meet the unique needs of our clients. Our approach is rooted in understanding industry dynamics and leveraging our extensive network to connect top-tier talent with leading organizations. We emphasize quality placements through rigorous testing and personalized recruitment strategies, ensuring both client satisfaction and candidate success. Our commitment extends beyond mere staffing; we foster long-term partnerships by continuously adapting to industry trends and client requirements. By prioritizing candidate training and professional development, we empower individuals to excel in their roles and contribute effectively to organizational growth.

Title: Utilization Management Nurse Specialist Location: 100% Remote Terms of Employment W2 Contract, 6 months This position is 100% remote. The selected candidate must be based in EST or CST time zone and must be comfortable working 8:00 AM – 5:00 PM (EST).

Work with a leading healthcare organization as a Utilization Management Nurse Specialist. This role is critical to the Utilization Services team, focusing on high-volume clinical reviews to ensure members receive appropriate care. You will join a fast-paced environment where your clinical expertise in Home Health and Infertility services will directly impact member outcomes and operational efficiency. You will… Conduct clinical reviews for commercial and Federal Employee Program (FEP) plans. Review a variety of cases including inpatient scheduled surgeries/admissions, physical therapy, occupational therapy, and speech therapy. Perform high-volume home health and infertility reviews, which constitute the majority of the workload. Navigate and utilize MCG (Milliman Care Guidelines) to determine the medical necessity of requested services. Maintain a high production rate of 30 to 35 case reviews per day. Utilize internal systems including Facets and Health Edge (Guiding Care) for authorization and documentation.