Utilization Management Nurse Consultant
Core
Review clinical information and apply evidence-based criteria to support utilization and coverage determinations 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, Evidence-based criteria application, Provider communication, Care plan coordination, System navigation
Preferred skills
Managed Care experience, Utilization Management experience, Med-Surg or specialty clinical experience
Technologies
Microsoft Office 365, EHR portals, VPN
Responsibilities
Review and assess clinical information to support utilization and coverage determinations, Collaborate with providers and care teams to facilitate appropriate treatment, Identify opportunities for care management referrals, Promote quality and cost-effective healthcare outcomes, Serve as a clinical resource for utilization activities
Seniority
Mid-level, hands-on IC