Utilization Management Nurse Consultant
Core
Review clinical information and apply evidence-based criteria to support coverage determinations and coordinate healthcare services across the continuum of care.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination plans for health plan members
Domain
Health Insurance / Utilization Management
Required skills
Clinical assessment, decision-making, care coordination, evidence-based criteria application, multi-system navigation, stakeholder collaboration
Preferred skills
Managed care experience, Utilization Management experience, Med-Surg or specialty nursing experience
Technologies
Multiple computer systems
Responsibilities
Review clinical information for coverage determinations, Assess and monitor healthcare services, Collaborate with providers on treatment plans, Identify opportunities to improve quality and efficiency, Connect members to additional programs, Serve as a clinical resource
Seniority
Mid-level, hands-on IC