Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation
Communicate with providers and other parties to facilitate care/treatment
Identify members for referral opportunities to integrate with other products, services and/or programs
Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

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
2+ years of clinical experience required in med surg or specialty area preferred
Managed Care experience preferred, especially Utilization Management
Associates Degree required, BSN preferred

Utilization Management Nurse Consultant

About this role