Utilization Management Nurse Consultant
Core
Review clinical information and apply evidence-based criteria to support coverage determinations for healthcare members.
Role type
Utilization Management Nurse Consultant
Builds
Coverage decisions and care coordination for health plan members
Domain
Healthcare / Utilization Management
Required skills
Clinical judgment, Evidence-based criteria application, Provider collaboration, Healthcare quality improvement, Member program coordination, State RN licensure
Preferred skills
BSN, Medical-Surgical or specialty nursing experience, Utilization Management or Managed Care experience, Eastern or Central Time Zone location
Technologies
Microsoft Office 365, EHR portals, VPN, Digital communication tools
Responsibilities
Review clinical information to support coverage determinations, Collaborate with providers to coordinate care, Identify opportunities to improve healthcare quality and efficiency, Connect members with additional programs and services, Serve as a clinical resource for utilization activities
Seniority
Mid-level, hands-on IC