UM Nurse Consultant | Post Acute Specialty UM
Core
Evaluates medical necessity and appropriateness of post-acute services (SNF, IRF, LTACH, Home Health) using clinical criteria and regulatory requirements to support quality, cost-effective care.
Role type
Utilization Management Nurse Consultant
Builds
Post-acute care authorization decisions and care transition plans
Domain
Healthcare / Utilization Management
Deliverable
client delivery
Required skills
Clinical assessment, critical thinking, medical record review, knowledge of post-acute levels of care, evidence-based criteria application, EMR/UM platform proficiency
Preferred skills
Medicaid/Medicare/Commercial plan experience, complex discharge planning, state/federal regulatory knowledge, remote work experience
Technologies
MCG, electronic medical records, utilization management platforms
Responsibilities
Perform UM reviews and authorizations for post-acute services; collaborate with providers and care managers to facilitate timely care transitions; apply clinical criteria to determine medical necessity
Seniority
Mid-level, hands-on IC