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
• Utilization management is a 24/7 operation. Work schedules will include a minimum of 6 weekend rotations per year, as well as holidays and evening rotations.
• Must be willing and able to work Mon-Fri 8:30am-5pm or 10:30 am – 7pm in time zone of work being supported.
• 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

• 3+ years of clinical experience required
• Managed Care experience preferred
• BSN preferred