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Utilization Management Nurse Consultant
Ref No.: 18-11055
Location: Downers Grove, Illinois
Start Date / End Date: 09/10/2018 to 01/09/2019
Duration:3-4 month(s)

Description/Comment: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

Additional Job Details:Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding • Effective communication skills, both verbal and written. • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment • Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the1 telephone and typing on the computer. • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. • Typical office working environment with productivity and quality expectations