Job Summary
A healthcare and retail pharmacy company is filling a position for a Telecommute UM Nurse Consultant.
Candidates will be responsible for the following:
- Utilizing clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
- 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
- Gathering clinical information and applying the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
Skills and Requirements Include:
- RN with current unrestricted state licensure
- 3+ years of clinical experience
- Associates Degree
- Ability to perform close inspection of hand written and computer generated documents
- Ability to communicate with providers and other parties to facilitate care/treatment
- Ability to identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
