Utilization Management Nurse Consultant
Core
Assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members using clinical judgment and criteria.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination recommendations
Domain
Healthcare / Insurance / Managed Care
Deliverable
client delivery
Required skills
Registered Nurse licensure, acute/critical care experience, clinical criteria application, policy interpretation, provider communication, document review, multitasking, computer proficiency
Preferred skills
Med surg or specialty area experience, Managed Care experience, Utilization Management experience
Responsibilities
Render coverage determination/recommendations along the continuum of care, communicate with providers to facilitate care/treatment, identify members for referral opportunities, consult on utilization/benefit management administration
Seniority
Mid-level, hands-on IC