Utilization Management Nurse Consultant
Core
Review clinical information to support coverage determinations and care recommendations, applying guidelines and professional judgment to utilization management decisions.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care recommendations for health plan members
Domain
Healthcare / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Adult acute care nursing, Critical care nursing, Clinical guidelines application, Interdisciplinary collaboration, Care coordination, Computer system navigation
Preferred skills
Med-Surg experience, Specialty clinical experience, Utilization Management experience, Managed Care experience, BSN degree
Responsibilities
Review and assess clinical information for coverage determinations, Apply clinical guidelines to utilization decisions, Collaborate with providers to coordinate care, Identify care management referral opportunities, Promote quality outcomes and member-centered care, Serve as a clinical resource for stakeholders