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 members using clinical criteria and guidelines.
Role type
Utilization Management Nurse Consultant
Builds
Coverage determinations and care coordination recommendations
Domain
Healthcare / Insurance / Medicare
Required skills
Registered Nurse licensure, Med/Surg clinical experience, Medicare knowledge, 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 to render coverage determinations, communicate with providers to facilitate care, identify members for referral opportunities, consult on utilization management function
Seniority
Mid-level, hands-on IC