Lead Utilization Management Nurse Consultant

Your Role Join our dedicated Federal Employee Program (FEP) team, focused on delivering exceptional healthcare coverage to federal employees, retirees, and their families. As a Lead Utilization Management Nurse Consultant, you will collaborate with a dynamic team overseeing prior authorization, concurrent, and post-service medical reviews. Your expertise will ensure that members receive the right services at the right time, while also maintaining medical necessity and adherence to their benefits. This role is key to helping reduce healthcare costs and enhance patient care. We pride ourselves on fostering leadership development at all levels, and we continuously seek opportunities for our employees to grow both personally and professionally. We are looking for leaders who are inspired by innovative and analytical thinking, who can build high-performing teams, achieve results ethically, and nurture a culture of continuous improvement. Your Knowledge and Experience Must possess a bachelor's degree or equivalent experience. Current RN License is essential. A minimum of 7 years of relevant experience is required. Preferred: 4 years of clinical experience. Utilization management experience is a plus. Proficient in Microsoft Suite and related computer skills. Ability to assess, evaluate, and interpret clinical information and care plans independently. Strong clinical documentation and problem-solving skills. Excellent analytical capabilities. Familiarity with regulatory and accreditation standards (URAC, NCQA, DMHC, CMSA) is preferred. Must be able to sit for extended periods while analyzing clinical information across multiple screens. This role requires a high level of autonomy in decision-making.

Created: 2026-03-04