Utilization Management Nurse Consultant
Core
Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate 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
Required skills
Clinical judgment, coverage determination, care coordination, policy application, provider communication, document review, multitasking, computer proficiency, telephone communication
Preferred skills
Med surg or specialty area experience, Managed Care experience, Utilization Management experience
Technologies
Multiple healthcare systems, PC, keyboarding
Responsibilities
Gather clinical information and apply guidelines to render coverage determinations; Communicate with providers to facilitate care; Identify members for referral opportunities; Consult with internal and external constituents on benefit management; Monitor and evaluate healthcare service utilization.
Seniority
Mid-level, hands-on IC