Utilization Management Nurse Consultant – Weekend

Utilization Management Nurse Consultant – Weekend

Requirements

• Active and unrestricted Registered Nurse in state of residence
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute setting (ex: ER, triage, ICU, Med/Surg)
• Willing and able to work four 10hr days including every Weekend, both Saturday and Sunday, and two weekday shifts of 10hrs each (Wednesday/Friday), also includes Holiday and late rotations.

Responsibilities

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or benefit programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• UMNC meets set productivity and quality expectations.

Preferred Qualifications

• Utilization review experience
• Experience with LTAC, skilled rehab, or home health
• Managed Care experience