Utilization Management Nurse Consultant
Core
Review clinical cases to assess medical necessity, coordinate care, and support coverage determinations for healthcare members.
Role type
Utilization Management Nurse Consultant
Builds
Care coordination and coverage decisions for health plan members
Domain
Healthcare / Utilization Management
Required skills
Clinical assessment, care coordination, evidence-based criteria application, provider collaboration, program referral
Preferred skills
Managed care experience, specialty area clinical experience, BSN degree
Technologies
Microsoft Office 365, EHR portals, VPN, Teams, Outlook, Excel
Responsibilities
Review clinical information to support coverage determinations, Collaborate with providers to coordinate treatment, Identify opportunities to improve healthcare quality, Refer members to appropriate health programs, Serve as a clinical resource for utilization questions
Seniority
Mid-level, hands-on IC