Utilization Management Nurse Consultant
Core
Utilizes clinical experience to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members, rendering coverage determinations along the continuum of care.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination for health plan members
Domain
Healthcare / Managed Care
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 area experience, Managed Care experience, Utilization Management experience
Technologies
Multiple healthcare systems, PC monitor, telephone
Responsibilities
Assess and evaluate healthcare service options, gather clinical information for coverage decisions, communicate with providers to facilitate care, identify referral opportunities, consult on utilization management function
Seniority
Mid-level, hands-on IC