Utilization Management Nurse Consultant
Core
Review clinical information and apply guidelines to support coverage determinations and care coordination for healthcare members.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination plans
Domain
Healthcare / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical assessment, critical thinking, care coordination, policy application, system navigation
Preferred skills
Managed care experience, specialty nursing experience, BSN degree
Technologies
Microsoft Office 365, EHR portals, VPN
Responsibilities
Review clinical information for coverage determinations, Assess and monitor healthcare services, Collaborate with providers on care planning, Identify opportunities to improve care quality, Connect members with support programs, Serve as a clinical resource for stakeholders