Utilization Management Nurse

As a Utilization Management (UM) Nurse, you will provide UM services, transition of care and support to members and health care providers. You will utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical necessity criteria (InterQual), and benefit information to provide consultation and responses to UM requests. You will proactively assess and assist members to help move them through the continuum of care by utilizing services and resources efficiently. You will be part of a multidisciplinary team to continuously look for ways to improve processes and maximize health dollars for the members. Duties include providing members and health care providers with appropriate and timely prior approval, precertification and continued stay reviews and support, and working with health care provider staff in a courteous and professional manner in gathering medical information and facilitating discharge planning.