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Utilization Management Nurse Consultant
Ref No.: 18-22843
Location: Chicago, Illinois
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Requires an RN with unrestricted active license
. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical
judgment to render coverage determination/recommendation along the continuum of care
• Communicates with providers and other parties to facilitate care/treatment
• Identifies members for referral opportunities to integrate with other products, services and/or programs
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the
utilization/benefit management function