What are the responsibilities and job description for the Utilization Management Nurse Consultant (Remote) position at Talent Pairing?
This is a remote position.
We are seeking a Registered Nurse with clinical experience to join our Utilization Management team. In this role, you will utilize your clinical skills in collaboration with other healthcare professionals to assess, plan, and coordinate appropriate healthcare services for members. Your responsibilities will include gathering clinical information, applying clinical criteria, making coverage determinations, and communicating with providers and members to facilitate care. You will also identify opportunities to improve healthcare service effectiveness and benefit utilization. This position requires the ability to multitask, adapt to a fast-paced environment, and work remotely full-time.
Key Responsibilities :
- Assess, plan, and coordinate healthcare services and benefits for members.
- Apply clinical criteria and guidelines to determine coverage recommendations.
- Communicate with providers to facilitate care and identify opportunities for referrals.
- Collaborate with internal and external stakeholders to manage utilization / benefit functions.
- Monitor and evaluate healthcare service quality and effectiveness.
Requirements
Required Qualifications :
Preferred Qualifications :
Benefits
Benefits :
This position is eligible for a bonus and additional incentives.
