Utilization Management Nurse Consultant
Core
Review clinical information and apply evidence-based guidelines to support coverage and care decisions for health plan members.
Role type
Utilization Management Nurse Consultant
Builds
Coverage and care decisions, care coordination, and benefit utilization improvements
Domain
Healthcare / Insurance / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical judgment, evidence-based guideline application, care coordination, resource connection, system navigation
Preferred skills
Medical-Surgical or specialty nursing experience, Managed Care experience, BSN degree
Technologies
Microsoft Office 365, EHR portals, VPN
Responsibilities
Review clinical information to support coverage decisions, Collaborate with providers to coordinate healthcare services, Identify opportunities to improve care quality and outcomes, Support members by connecting them to relevant programs, Serve as a clinical resource for utilization activities
Seniority
Mid-level, hands-on IC