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.

Serve as a key advisor who actively engages with members to foster a caring and trusting level of connection in order to support their chronic and/or complex health care needs and concerns. Create and manage unique, individualized care plans that ensure the best possible health care goals and complex health needs are reasonably met. Partner with members, families, health care providers and community resources to coordinate and facilitate care and services.