Utilization Management Nurse Consultant

Job Summary

A company is looking for a Utilization Management Nurse Consultant.

Key Responsibilities:

• Conduct retrospective reviews to ensure appropriate utilization of services and adherence to medical necessity criteria
• Provide expertise and consultation to internal and external stakeholders in coordinating and administering utilization management
• Evaluate and facilitate appropriate healthcare services and benefits through collaborative processes

Required Qualifications:

• Minimum of 3 years of clinical experience and managed care experience
• Minimum of 3 years of utilization management retrospective and claims review experience
• Proficiency with Microsoft Office Suite products
• Current active and unrestricted RN licensure in the state of residence
• Associate's degree required, BSN preferred