Utilization Management Nurse Consultant
Core
A Utilization Management Nurse Consultant assesses, plans, and coordinates healthcare services and benefits for members using clinical judgment and criteria to determine coverage and facilitate appropriate care.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination recommendations
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
Registered Nurse licensure, adult acute/critical care experience, clinical criteria application, provider communication, policy interpretation, multitasking, computer proficiency
Preferred skills
Med surg or specialty clinical experience, Managed Care experience, Utilization Management experience, Eastern Standard Time zone residency
Technologies
Microsoft Office 365, EHR portals, VPN, Teams, Outlook, Excel
Responsibilities
Assess and plan healthcare service options, gather clinical information for coverage determinations, communicate with providers to facilitate care, identify referral opportunities, consult on utilization management administration, monitor and evaluate service effectiveness
Seniority
Mid-level, hands-on IC