Utilization Management Nurse Consultant
Core
Utilization Management Nurse Consultant assessing, planning, and coordinating healthcare services and benefits for members using clinical judgment and criteria.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination recommendations
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
Registered Nurse licensure, adult acute/critical care experience, clinical criteria application, provider communication, document review, multitasking, computer proficiency
Preferred skills
Med surg or specialty area experience, Managed Care experience, Utilization Management experience
Responsibilities
Assess and evaluate options to facilitate appropriate healthcare services, gather clinical information to render coverage determinations, communicate with providers to facilitate care, identify referral opportunities, consult on utilization management administration
Seniority
Mid-level, hands-on IC