Utilization Management Nurse Consultant- Medical Review

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Requirements:

• Registered Nurse – active license
• 3+ Years of clinical experience
• 1+ Year of Utilization Review Management and/or Medical Management experience.
• Must have active and unrestricted RN license in the state you reside.
• 5 years demonstrated to make thorough independent decisions using clinical judgement
• 5 Years proficient use of equipment experience including phone, computer, etc and clinical documentation systems

Responsibilities:

• Implement, coordinate, monitor and evaluate medical review cases.
• Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client.
• Assist management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring, feedback,
• Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet client needs.
• Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction.