Utilization Management, Nurse Consultant (Remote)
Core
Utilizes clinical experience to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members, rendering coverage determinations along the continuum of care.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination for health plan members
Domain
Health Insurance / Utilization Management
Required skills
Registered Nurse licensure, acute/critical care experience, clinical criteria application, policy interpretation, provider communication, multitasking, computer proficiency
Preferred skills
Med surg or specialty area experience, Managed Care experience, Utilization Management experience, Eastern time zone residence
Technologies
Microsoft Office 365, EHR portals, VPN, Teams, Outlook, Word, Excel, PowerPoint
Responsibilities
Assess and plan healthcare service options, gather clinical information to render coverage determinations, communicate with providers to facilitate care, identify referral opportunities, consult on utilization management administration
Seniority
Mid-level, hands-on IC