Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

Requirements

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
• Must have active current and unrestricted RN licensure in state of residence
• Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
• Proficiency with computer skills which includes navigating multiple systems and keyboarding
• Effective communication skills, both verbal and written

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 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

Preferred Qualifications

• 2+ years of clinical experience required in med surg or specialty area
• Managed Care experience preferred, especially Utilization Management
• Preference for those residing in CST zones
• BSN preferred