Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

Requirements

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• 1+ years of clinical experience in acute or post acute setting
• Requirement to reside in EST or CST zone
• Utilization Management is a 24/7 operation and work schedule will include weekends, holidays and evening hours

Responsibilities

• 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

• Managed Care experience preferred
• Associates Degree required
• BSN preferred