Quality Management Nurse Consultant Job at Medical Recruitment Strategies
**MUST HAVE MEDCOMPASS or ASSURECARE exp.
**MUST HAVE CRITICAL CARE or MEDICAL SURGICAL
**MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG
Fully Remote- WFH anywhere in the US
Position Summary:
Position open to WFH Anywhere in the U.S
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate health care services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Health-care Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
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