Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program
Ensure the member is receiving the appropriate care at the appropriate time and location
Review written clinical records
Assure medical necessity and appropriate benefit utilization
Facilitate safe and efficient discharge planning
Work closely with facilities and providers to meet the complex needs of the member
Develop, implement, and support Health Strategies, policies, and programs
Gather clinical information and apply the appropriate clinical criteria/guideline for coverage determination

Registered Nurse (RN) with current unrestricted US licensure in their state of residence is required
2+ years clinical practice experience as an RN required
2+ Years Utilization Management experience
Must be willing to travel to the local office as needed if living within approximately 45 minutes/miles
Bilingual proficiency preferred
1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications

Utilization Management Nurse Consultant

About this role