Utilization Management Nurse Consultant - Weekends S/S/M/T (4-10 hour shifts)
Core
Utilization Management Nurse Consultant assessing, planning, and coordinating healthcare services and benefits for Medicare members to facilitate appropriate care.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination recommendations for Medicare members
Domain
Healthcare / Medicare Utilization Management
Required skills
Registered Nurse licensure, Med/Surg clinical experience, Medicare experience, Microsoft Office proficiency, clinical judgment
Preferred skills
Prior Authorization experience, Managed care experience, MedCompass usage, Ambulatory surgery experience
Technologies
Microsoft Office (Outlook, Teams, Excel), MedCompass
Responsibilities
Assess and evaluate options to facilitate appropriate healthcare services; Gather clinical information and apply criteria to render coverage determinations; Communicate with providers to facilitate care; Identify members for referral opportunities; Consult on utilization/benefit management function
Seniority
Mid-level, hands-on IC