Utilization Management, Nurse Consultant (Remote, EST)
Core
Utilization Management Nurse Consultant assessing, planning, and coordinating healthcare services and benefits for members using clinical judgment and guidelines.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination recommendations
Domain
Health Insurance / Utilization Management
Deliverable
client delivery
Required skills
Registered Nurse licensure, adult acute/critical care experience, clinical criteria application, provider communication, multitasking, computer proficiency
Preferred skills
Med surg/specialty experience, Managed Care experience, Utilization Management experience
Technologies
Microsoft Office 365, EHR portals, VPN
Responsibilities
Assess and plan healthcare service options, gather clinical information for coverage determinations, communicate with providers to facilitate care, identify referral opportunities, consult on benefit management, perform close inspection of documents
Seniority
Mid-level, hands-on IC