Utilization Management Nurse Consultant

Total Med Staffing, Linthicum MD


Job Description:

  • Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
  • Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare 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 Healthcare 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
  • Participates in care rounds


  • RN with an unrestricted licenses.
  • 3+ years clinical practice experience, e.g., hospital setting,
  • alternative care setting such as home health or ambulatory care required.
  • Utilization Management experience
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