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Utilization Management Nurse Consultant
Ref No.: 17-24391
Location: New Albany, Ohio

Summary:
  • The UM Nurse Consultant reviews inpatient cases for medical necessity.
  • Levels of care that are reviewed include acute inpatient hospital, LTACH (long term acute care), Acute Inpatient Rehab, and SNF (skilled nursing facility).
  • Criteria utilized includes MCG and the Medicare Benefits manual.
  • The UM nurse consultant collaborates closely with care managers and the medical directors.
Responsibilities:
  • Telephonic utilization review of inpatient cases
  • Reviews inpatient cases for medical necessity
  • Utilizes MCG and the Medicare Benefits Manual for criteria
  • Close collaboration with care managers and the medical directors
  • Rewarding position obtaining care that our members need
  • Close team environment
Required Qualifications:
  • 3-5 years of clinical experience required
  • Must work well independently and also in a group setting
  • Must be able to type with both hands