Utilization Management Nurse Consultant
Core
Authorize procedures and services using clinical criteria and guidelines via precertification and medical director referrals.
Role type
Utilization Management Nurse Consultant
Builds
Precertification decisions for healthcare services
Domain
Healthcare utilization management
Required skills
Clinical nursing judgment, Evidence-based practice application, Clinical practice guidelines knowledge, Precertification criteria application, Provider communication, Computer proficiency
Preferred skills
Prior authorization experience, Compact RN licensure
Responsibilities
Review clinical information from providers, Authorize procedures or services, Initiate Medical Director referrals, Communicate with providers via phone and digital channels
Seniority
Mid-level, hands-on IC
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