Utilization Management Nurse Consultant
Core
Review clinical information to make coverage and care recommendations, ensuring members receive appropriate, high-quality healthcare services.
Role type
Utilization Management Nurse Consultant
Builds
Care management programs and service integration
Domain
Healthcare / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical judgment, care coordination, policy application, stakeholder collaboration, care management program identification
Preferred skills
Med-Surg or specialty clinical experience, Utilization Management experience, Managed Care experience
Technologies
Microsoft Office 365, EHR portals, VPN, Teams, Outlook, Excel
Responsibilities
Review and assess clinical information to make coverage and care recommendations, Apply clinical guidelines and nursing judgment across the continuum of care, Collaborate with providers and care teams to support treatment plans, Identify opportunities for care management programs and service integration, Promote quality outcomes and effective healthcare utilization, Serve as a clinical resource for internal and external stakeholders