Utilization Management Clinical ConsultantPrimary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
- 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
- 3 or more years recent clinical practice experience, e.g., hospital setting, alternative care setting such as ambulatory care required
- Behavioral/Mental Health experience preferred
- Managed care/utilization review experience preferred
- Registered Nurse (RN) with unrestricted state license required
Typical office working environment with productivity and quality expectations
proficiency with computer skills which includes navigating multiple systems and
keyboarding. Effective communication skills, both verbal and written. Ability
to multitask, prioritize and effectively adapt to a fast paced changing environment.
Sedentary work involving periods of sitting, talking and listening. Work
requires sitting for extended periods, talking on the telephone and typing on
the computer. Work requires the ability to perform close inspection of hand
written and computer generated documents as well as the PC monitor.
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