RN - Healthcare Consultant III - Utilization Management Clinical Consultant

ICONMA, LLC • United States, United States • 2d ago

Our Client, a Retail Pharmacy company, is looking for a RN - Healthcare Consultant III - Utilization Management Clinical Consultant for their Remote location. Responsibilities:

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.

Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.

Identifies members who may benefit from care management programs or other post discharge programs and facilitates referrals.

Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Requirements:

3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

Clinical experience in ER, ICU, or Critical Care preferred.

Managed Care/Utilization Management experience.

Demonstrate making thorough independent decisions using clinical judgement.

Proficient use of equipment experience including phone, computer, etc. and clinical documentation systems.

Why Should You Apply?

Health Benefits

Referral Program

Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.

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