Utilization Management Nurse Consultant EST (Remote), Multiple Locations

(Mon-Fri 10:30am-7:00pm or 11:30am-8:00pm EST) R0673895 At bolthires, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.And we do it all with heart, each and every day. Position Information Schedule: Monday–Friday (Shift times vary based on business needs; must be open to working any of the following EST shifts: 10:30am-7:00pm, or 11:30am-8:00pm EST Hours) Location: 100%Remote (U.S. only) About Us American Health Holding, Inc. (AHH), a division of bolthires/bolthires, is a URAC-accredited medical management organization founded in 1993. We provide flexible, bolthires-effective care management solutions that promote high-quality healthcare for members.Position Summary Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorize care, and escalate cases when needed, all while navigating multiple systems and maintaining accurate documentation. This role suits nurses who thrive in fast-paced environments, are highly organized, and comfortable with computer-based work. Key Responsibilities • Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render determination/recommendation along the continuum of care. • Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs.• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. • Work in clinical telephone queue for 2 to 4 hours a day working with providers to secure additional information for prior authorization review. Remote Work Expectations • This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications • Active unrestricted state Registered Nurse licensure in state of residence required. • Minimum 5 years of relevant experience in Nursing. • At least 1 year of Utilization Management experience in concurrent review or prior authorization. • Strong decision-making skills and clinical judgment in independent scenarios. • Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms.• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications • 1+ year of experience in a managed care organization (MCO). • Experience in a high-volume clinical call center or prior remote work environment. Education • Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay RangeThe typical pay range for this role is: $29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a bolthires bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be.In addition to our competitive wages, our great benefits include: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-bolthires programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visit We anticipate the application window for this opening will close on: 09/03/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. 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