Utilization Management Nurse Consultant - Columbus
1 month ago
Job summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. 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.Responsibilities
- Gathers clinical information and applies the appropriate clinical criteria/guideline policy procedure
- Renders coverage determination/recommendation along the continuum of care
- Communicates with providers other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products services programs
Job description
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