Utilization Management Nurse Consultant
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About The Position
Utilization Management is a 24/7 operation and the work schedule may include weekends, holidays, and evening hours. The role involves utilizing 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. Responsibilities include gathering clinical information, applying appropriate clinical criteria/guidelines, communicating with providers, identifying referral opportunities, promoting quality effectiveness of healthcare services, and consulting with internal and external constituents in the utilization/benefit management function. The work environment is typical office-based with productivity and quality expectations, requiring close inspection of documents and prolonged periods of sitting, talking, and typing. Proficiency with computer skills is necessary, along with effective verbal and written communication skills.
