Utilization Management Nurse Consultant, Illinois RN License Required

Job Description: • Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program • Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function • Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care • Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage/crisis support) • Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment • Identifies members who may benefit from care management programs and facilitates referral • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization Requirements: • Must have active, current, and unrestricted RN licensure in state of IL • Must be available to work M-F; 8am - 5pm CST • Willingness to obtain additional state licenses • 3+ years of clinical practice experience in an inpatient setting as an RN • Managed care experience (Preferred) • Discharge planning experience (Preferred) • Utilization Management experience (Preferred) • ASN Required, BSN Preferred Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation, and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job Apply To this Job