Utilization Management Nurse Consultant – Weekend

Role Overview

• Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate healthcare services and benefits for members.
• Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products, services, or benefit programs.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Meet set productivity and quality expectations as established by UMNC.

Requirements

• Registered Nurse
• Diploma RN acceptable; Associate degree / BSN preferred
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting
• 1+ years of Utilization Management / Care Management Experience
• Must have active current and unrestricted RN licensure in state of residence.
• May be required to obtain additional Nursing Licenses as business needs require.
• Utilization review experience preferred
• Experience with LTAC, skilled rehab, or home health preferred
• Managed Care experience preferred
• BSN preferred

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility