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.

This role offers the opportunity to help redefine healthcare by providing compassionate, high-quality virtual care to patients across their healthcare journey. As a Nurse Practitioner, you will connect with members using various modalities to assess their needs and goals, provide clinical guidance, and navigate members to resources to improve their health outcomes. This clinician will work with a multidisciplinary team to help optimize patients' health outcomes.

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. This role involves collecting and reviewing clinical information from providers, spending the majority of the time at a desk and on the phone. The schedule may include weekends, holidays, and evening hours as Utilization Management is a 24/7 operation. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral when needed.

Establish maximum value for Hanger's clients through successful implementation of ACP clinical programs and rehab technologies, with a focus on nursing integration of respiratory, cardiopulmonary, and other rehab clinical programs in post-acute care settings. The Nurse Clinical Ops Consultant will collaborate with field ops, marketing, and product development teams. Will report directly to the Director of Clinical Services.