Job Description
Randstad Healthcare is hiring for a
Utilization Management Clinical Consultant - Registered Nurse to work remotely.
***Must be licensed as a RN in Arizona or hold a compact license to be considered***
The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to assess the medical necessity, appropriateness, and quality of behavioral health services for adult and child/adolescent members. This role supports appropriate utilization of benefits across the continuum of care through collaboration, clinical review, and stakeholder communication.
Primary Duties & Responsibilities:
- Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions.
- Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks.
- Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions.
- Conduct concurrent reviews to monitor ongoing inpatient or outpatient treatment and support continuity of care.
- Identify members who may benefit from care management programs and facilitate appropriate referrals.
- Provide urgent or emergent clinical interventions when required, including triage and crisis support.
- Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care.
- Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines.
- Develop and support initiatives that enhance quality effectiveness and benefit utilization.
- Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes.
Essential Qualifications:
Current and active RN in Arizona or Compact License
Associate's degree required for RN applicants.
- Working knowledge of behavioral health terminology, clinical documentation, and utilization management principles.
- Strong critical thinking, problem-solving, and decision-making skills.
- Ability to evaluate clinical needs while balancing quality, cost, and member-centered care.
- Effective communication skills with diverse clinical staff, members, and community partners.
- Ability to handle sensitive and confidential information ethically and responsibly.
- Digital literacy and ability to function effectively in a virtual, desk-based work environment.
- Cultural competence and ability to work with diverse populations and interdisciplinary teams.
SCHEDULE:
- Standard schedule: Monday-Friday, 8:00 AM-5:00 PM Arizona time.
- Occasional holiday or weekend coverage required through rotation.
6 MONTH CONTRACT TO START
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Contract work, Temporary work, Work experience placement, Remote work, Monday to Friday