Utilization Management Nurse Consultant

Job Summary

A company is looking for a Utilization Management Nurse Consultant.

Key Responsibilities:

• Review services for medical necessity, coordinate discharge planning, and ensure appropriate benefit utilization
• Utilize clinical skills to document and communicate all aspects of the utilization/benefit management program
• Apply clinical criteria/guidelines and policy to render coverage determination/recommendation along the continuum of care

Required Qualifications:

• Active, current, and unrestricted RN licensure in state of residence
• 3+ years of clinical RN experience
• Experience in healthcare utilization management, critical care, emergency department, or case management
• MS Office Suites experience
• Associates degree required; BSN preferred