Nurse Consultant Resume Sample
Susie West
9108 Lavinia Squares,
Houston,
TX
+1 (555) 555 7805
Work Experience
Senior Nurse Consultant
02/2017
-
PRESENT
Boston, MA
- Direct clinical practice experience e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Extensive knowledge of medical issues and trends sufficient to provide expert advice and assistance to management and supervisors and to assist in the development of policies and procedures related to health programs
- Knowledge of the agency's mission and it's applicability to medical standards for weapon-carrying positions
- Comprehensive understanding of the physical requirements and potentially stress related factors of various agency positions
- Research background information, the origin of laws, and the intended impact in order to effectively interpret and implement clinical health care policies and provide medical review recommendations and guidance to the Contractors, leadership and other internal and external entities as needed
- Collaborate and lead teams of other clinical staff in the to ensure consistent and accurate implementation of clinical policy and programs
- Work with across the Agency to identify and monitor program vulnerabilities and effect changes in policy as necessary
- Provide nursing-related consultation and technical assistance
Nurse Consultant
04/2010
-
09/2016
New York, NY
- Serves as an official liaison and collaborate with others across service and/or discipline lines to establish and maintain programs that influence organizational mission, health care and maintains responsibility for outcomes
- Researches, analyzes, and prepares briefing papers for high-level managers on various policy issues
- Maintains relationships with other federal agencies and external constituencies to promote health policies that protect patient safety, promote innovation, and avoid regulatory duplication
- Utilizes expert nurse consulting skills in making decisions that significantly affect context, interpretation, or development of policies and programs
- Clinical experience, (ex: ICU, Med/Surge, skilled nursing, long term care, post acute required)
- Clinical (ex: skilled facilities, LTAC, subacute unit within a hospital) experience required
- Clinical experience (acute, med/surg) required
L&I Occupational Nurse Consultant
08/2003
-
10/2009
Philadelphia, PA
- Functional - Nursing/Clinical coverage and policies/1-3 Years
- Functional - Nursing/Legal and benefit interpretation/1-3 Years
- Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
- Functional - Nursing/Medical-Surgical Care/4-6 Years
- Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
- Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
- Technical - Computer Operations/System and Console Operations/4-6 Years/End User
- Skill in analyzing data defining health care needs of a defined population using standardized assessment tools and operating computer programs and databases such as Excel, Access, Word, etc
- Apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations
Education
Strayer University - Loudoun Campus
1998 - 2002
Master's Degree in Nursing
Professional Skills
- Strong computer skills including Windows, Microsoft Office, including Excel and Outlook and strong keyboarding skills
- Exercise independent and sound judgement, strong decision-making skills and well-developed interpersonal skills
- Outstanding interpersonal & negotiation skills to effectively establish positive relationships with all constituents both internal and externally
- Demonstrates good written and oral communications, organizational and leadership skills
- Demonstrates good written and oral communications, organizational and leadership skills. Computer literate
- Demonstrates good time management skills. Self starter
- Demonstrates good time management skills. Self-starter
How to write Nurse Consultant Resume
Nurse Consultant role is responsible for computer, clinical, microsoft, technology, interpersonal, intermediate, healthcare, organizational, sound, flash.
To write great resume for nurse consultant job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Nurse Consultant Resume
The section contact information is important in your nurse consultant resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Nurse Consultant Resume
The section work experience is an essential part of your nurse consultant resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous nurse consultant responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular nurse consultant position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Nurse Consultant resume experience can include:
- Strong organizational skills, such as the ability to prioritize and organize workload, time, materials, and resources
- Strong critical thinking and communication skills; required
- Excellent critical thinking skills; Required
- Strong computer and keyboarding skills (Required)
- Effective communication and customer service skills and the ability to compose technical reports using proper grammar
- Excellent customer service and verbal/written Communication skills
Education on a Nurse Consultant Resume
Make sure to make education a priority on your nurse consultant resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your nurse consultant experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Nurse Consultant Resume
When listing skills on your nurse consultant resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical nurse consultant skills:
- Strong analytical, and critical thinking skills
- Strong data analysis and report preparation skills
- Strong technology skills required
- Working knowledge of procedures, skills, and techniques of nursing service administration
- Teaching/training skills – Ability to combine a variety of teaching methods to accommodate all learning styles
- Organizational and problem-solving skills, including the ability to adapt to schedule changes and travel on short notice
List of Typical Experience For a Nurse Consultant Resume
1
Experience For UM Nurse Consultant Resume
- Multitask, prioritize and effectively adapt to a fast paced, deadline driven enviornment
- Multi-task, prioritize and effectively adapt to a fast paced, deadline driven environment
- Demonstrate diplomacy and tact to effectively avoid or diffuse high tension situations
- Effectively communicate orally and in writing with a diverse group of individuals
- Critical thinking skills. Ability to gather and analyze data, draw conclusions and use the information to make decisions
2
Experience For L&I Occupational Nurse Consultant Resume
- Manages resources effectively while maintaining accurate records of company related expenditures
- Exceptional communication skills are required, verbal, written and presentation
- Experience planning, implementing and evaluating effectiveness of programs for the management of cardiovascular disease
- Strong clinical nursing background, including assessment, care planning and delivery of care
- A current Washington state nursing license in good standing
- Direct clinical practice experience - e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Direct clinical practice experience -, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Coding experience in a clinical or managed care setting required
- State drivers license and unrestricted LPN license in good standing
3
Experience For Occupational Nurse Consultant Resume
- Experience in the research, review and writing of medical content
- Clinical experience required; Nursing/OB/GYN
- Experience assisting with oral surgery procedures; required
- Experience with Encoder Pro and other coding software desired
- Authorize home health care, skilled nursing facility admission, residential or hospice care or other services
- Experience within an acute care setting is required
- Acute Care experience in a Hospital Setting (Required)
- Experience working with health care databases and/or analytic tools
- Clinical experience required (med surg/NICU)
4
Experience For Senior Nurse Consultant Resume
- Experience in LTC Pharmacy or LTC facility
- Clinical experience and an RN license; Required
- Clinical experience; Required
- Clinical experience;Required
- Clinical experience required
5
Experience For Phone Nurse Consultant Resume
- Educates clinical policies and procedures for wound, ostomy and continence care prior to orientation
- Assesses wounds, fistulas and ostomies, provides treatment recommendations to the patient care team and evaluates treatment effectiveness
- Establish and maintain effective relationships with customers, gaining trust and respect
- Experience with Microsoft applications highly desired
- Supervisory experience including recruitment, hiring, training, designation of work and evaluation
- Clinical experience in a hospital setting that includes Medical/Surgical areas
- Opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
6
Experience For Nurse Consultant Description Resume
- Engages in skilled, active, interpretation and evaluation of observations, communications, information, and argumentation
- Experience in Oncology or Disease Specialty area
- Recent experience in telephonic case management of workers’ compensation claims
- Clinical experience required
- Requesting and reviewing opinions and medical records from treating physicians, and appropriate consulting
7
Experience For Telephonic Nurse Consultant Resume
- Requesting medical records and reviewing opinions from treating physicians and consulting Medical Review Officers
- Providing clarification and information to the public and providers on the reporting and neglect removal process, requirements and interpretations
- Performing complaint and/or standard surveys of nursing homes
- Preparing written Statement of Deficiencies documenting non-compliance issues
- Rewarding position obtaining care that our members need -Close team environment
- Willing to be licensed in states requiring same for Utilization Review
- Providing verbal and written customer service to individuals seeking employment with CBP
- Developing tools to monitor catastrophically injured individuals on an ongoing basis
8
Experience For Clinical Adherence Nurse Consultant Rn-telecommute Resume
- Demonstrating knowledge of the L&I Catastrophic Injury Program
- Understanding of budgetary principles and processes
- Utilizing the Current claims and documentation resources, keeps confidential information
- Nursing/Registered Nurse is required
- Reviews underwriting files utilizing technical expertise and consults with underwriting to assist in identifying potential future medical risk
- Compile the Pediatric Advisory Committee Roster, Meeting Participation and Temporary Voting Memorandums for each Pediatric Advisory Committee meeting
- Assess training needs and creates, authors and presents medical training to claim and business partner associates
- Professional writing sample (this can include authored scientific/professional journal articles, training documents and/or Power Points)
9
Experience For Nurse Consultant Senior Resume
- Assess ongoing health care and nursing needs of a worker to facilitate a plan of care
- Functional - Nursing/Clinical coverage and policies/1+ years
- Functional - Nursing/OB/GYN/1+ years
- Functional - Nursing/Maternal and Infant care/1+ years
- Functional - Nursing/Case Management/1+ years
- Service/Providing Solutions to Constituent Needs/3+ years
- Functional - Nursing/Medical-Surgical Care/4+ years
- Functional - Nursing/Medical-Surgical Care/1+ Years
- Functional - Nursing/Legal and benefit interpretation/1+Years
10
Experience For Supervisory Nurse Consultant Resume
- Functional - Nursing/Medical-Surgical Care/1+Years
- Proficient in navigating between multiple systems with dual monitors. Ability to accurately touch type on a keyboard at efficient speed; Required
- Proficient in navigating between multiple systems with dual monitors. Accurately touch type on a keyboard at efficient speed; Required
- Functional - Nursing/Critical Care/1+ Years
- Functional - Nursing/Neonatal Intensive Care/1+ Years
- Technical - Operating Systems/Windows/4+ Years/End User
- Sound understanding of quality improvement techniques and processes; and,
- Report writing and presentation to committees
- Proficient in navigating multiple systems with dual monitors
List of Typical Skills For a Nurse Consultant Resume
1
Skills For UM Nurse Consultant Resume
- Exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills
- Emergency department (or similar) experience; prior research experience
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding, proficiency in Word and Excel
- Proficiency with computer skills, navigating multiple systems and keyboarding; Required
- Actively listening to provider needs and effectively responding with appropriate and timely action in accordance with policies and procedures
- Effectively communicate verbally, in writing and via telephone about confidential and sensitive issues
- Clinical experience in a hospital setting that includes 1-3+ years of Med/Surg experience
- Computer skills including Microsoft Word and Outlook; required
2
Skills For L&I Occupational Nurse Consultant Resume
- The nurse uses clinical skills to coordinate, document and communicate all aspects of the utilization management program
- Utilizes technical skills to multitask through multiple systems at a rapid pace in order to process Precert requests timely and accurately
- Experience in healthcare consulting and/or healthcare provider operations experience related to case management
- Knowledge of and experience using evidence based approaches for health promotion and disease prevention and control at the population level
- Clinical experience and RN licensure required (hospital experience)
- Managed Care OR Clinical Quality (Healthcare Effectiveness Data and Information Set or HEDIS/Chart Review) experience
- Consulting experience in process improvement, supply chain or software implementation
3
Skills For Occupational Nurse Consultant Resume
- Strong clinical nursing background, including assessment, care planning, and delivery of care
- Manage multiple priorities and adapt in a fast paced environment. Being responsible for quality metrics
- Assist with effective use of health care benefits, access to available programs/services and determining next best actions to achieve health ambitions
- Preferably has 3-5 years of healthcare consulting experience
- Clinical experience in a hospital setting required
- Clinical experience required in a hospital setting
- Concurrent Review/Discharge planning experience required
- Gives due consideration to the evidence, context and relevant criteria surrounding the nature of a problem or question
- Consultative, administrative, or supervisory experience over registered nursing staff or health care professionals
4
Skills For Senior Nurse Consultant Resume
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
- Prioritize daily work lists to ensure the requests are completed timely
- Make independent decisions, prioritize and self direct daily activities with limited oversight
- Clinical Experience in Occupational Health, Rehabilitation
- Skill in clinical research and medical record documentation
- Establish and maintain effective relationships with individuals, the medical/health care community, and other professionals
- Prioritize and manage multiple tasks and meet deadlines
5
Skills For Phone Nurse Consultant Resume
- Med/Surg experience required
- Clinical experience required
- Case management and/or utilization review experience
- Clinical experience
- Acute experience required: ICU, critical care, Med/Surg
- Demonstrates intellectual humility, empathy, integrity, courage, and confidence to drive fair and purposeful judgment
- Clinical experience andconcurrent unrestricted State licensure (RN)
- Clinical experience and concurrent unrestricted State licensure (RN)
6
Skills For Nurse Consultant Description Resume
- Clinical experience with medical record documentation required
- Clinical experience and concurrent unrestricted State licensure (RN) is required
- Registered Nurse (RN) with 3+ Years Clinical Experience
- Provides treatment recommendations to the patient care team on infection prevention strategies, isolation requirements and evaluates treatment effectiveness
- Creates effective requests for medical information which focus on clarifying medical restrictions and limitations and their impact on work functionality
- Obtaining necessary information from providers and facilities concerning the care being provided to members
- Screening, reviewing and determining disposition of written initial allegation and/or investigation reports received from health care facilities
- Understanding how enforcing medical standards supports our Agency's mission
- Coordinating outreach efforts and assisting with business development to build relationships with key
7
Skills For Telephonic Nurse Consultant Resume
- Determining appropriateness of removing neglect findings from the Nurse Aide and/or Health Care Personnel Registry
- Entering and updating information in databases and spreadsheets
- Ensuring calls are answered in a timely manner in a cordial, courteous and helpful way consistent with Mercy’s service standards
- Working closely with case managers at the hospital for fax and telephonic reviews
- Obtaining necessary information from providers and facilities
- Working knowledge of current concepts in nursing
- Working knowledge of philosophy of nursing education
8
Skills For Clinical Adherence Nurse Consultant Rn-telecommute Resume
- Performing complaint and/or standard surveys of licensed home care, home health and hospice
- Assists in expediting medical care, negotiating the plan of care, coordinating return to work and facilitating communication among all involved parties
- This includes collaborating with providers and facilities during the review process and assisting with discharge planning to ensure quality care to the members
- The early identification of continuing care needs to facilitate discharge to the appropriate setting and discharge planning coordination
- Proficiency with MS Office Suite, navigating multiple systems and keyboarding
- Functional - Nursing/Discharge Planning/1+Years
- Functional - Nursing/Discharge Planning/1+ Years
- Functional - Nursing/Concurrent Review/discharge planning/4+ Years
9
Skills For Nurse Consultant Senior Resume
- Finds it worthwhile to consider multiple perspectives and sources of information when trying to resolve complex issues,
- Is interested in synthesizing information from research, data, and collegial discussions into guidelines that can be implemented in clinical practices,
- Enjoys communicating with healthcare providers, professional associations, and agency staff through meetings, written forms, and oral presentations
- We are seeking those UM professionals who live in New York
- Benefits Management/Interacting with Medical Professionals/3+ years/ADVANCED
10
Skills For Supervisory Nurse Consultant Resume
- Benefits Management/Maximizing Healthcare Quality/1+ years/FOUNDATION
- Leadership/Collaborating for Results/3+ years/ADVANCED
- Benefits Management/Supporting Medical Practice/3+ years/ADVANCED
- Leadership/Driving a Culture of Compliance/1+ years/FOUNDATION
- Service/Providing Solutions to Constituent Needs/3+ years/ADVANCED
- The assessment of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness
- General Business/Applying Reasoned Judgment/3+ years
List of Typical Responsibilities For a Nurse Consultant Resume
1
Responsibilities For UM Nurse Consultant Resume
- Exercise independent and sound judgment, strong decision making skills and well developed interpersonal skills
- Implements initial and ongoing competency skills training and evaluation
- Experience working with quality improvement to improve consistency of protocols relating to cardiovascular and cerebrovascular health
- Clinical Experience required (hospital setting, Med/Surg/Acute Unit)
- Experience interpreting federal and state laws and regulations related to public health and the delivery of clinical services
- Providing advice to management officials, supervisors and co-workers on the application of medical requirements and determination of medical qualification
- Nursing/Registered Nurse (RN) is Required
- Sets guidelines and proper training for efficient handling and managing of tasks by nursing and healthcare personnel
- Manages assigned caseload of complex cases by applying specialized training/knowledge to the assessment of cases and providing technical insight and advice
2
Responsibilities For L&I Occupational Nurse Consultant Resume
- Meets with nursing associations to discuss changes in principles, work ethics and other matters concerning nursing issues
- Collaborate with BKD’s payment reform service team to provide consulting services to clients related to new payment models including
- Review inpatient and outpatient UR reports for accuracy and quality; provide feedback to UR vendor. Identify problem areas with reports and propose changes/improvements in process
- Provide consultative services to OMD staff, health care providers and UR contractor in regard to complex worker's compensation cases. Ensure that the necessary clinical information is present, errors are intercepted, and recommendations are identified for procedures and accepted condition(s) in the claim
- Resolve billing issues and recommend coding changes
3
Responsibilities For Occupational Nurse Consultant Resume
- Coordinates the education, training and quality monitoring related to infection prevention for physicians, nurses, therapists and students
- Analyze medical records to determine accurate coding and determine if records accurately reflect the medical care being billed
- Responsible for participating in and or leading Medical Review work groups to review, maintain, and/or update Medical Review processes
- Provider education, outreach and training
- Write reports, briefing papers, decision and white papers
- Provides continuing education for physicians, nurses, therapists and students related wound care, fistula management and ostomy care
- Provides ongoing in-service education to medical and clinical staff
4
Responsibilities For Senior Nurse Consultant Resume
- Provides infection prevention training and education to patients
- Facilitate small and large groups and adult learning sessions
- Provide verbal and written customer service to individuals seeking employment with CBP
- Knowledge of the principles and theories of Nursing
- Knowledge of management problem-solving methods and program evaluation principles
- Use clinical knowledge to compare and interpret UR reports with information in the worker's claim file
- Resolve claim specific issues with medical providers, UR contractor and/or claims staff
5
Responsibilities For Phone Nurse Consultant Resume
- Review, analyze, and evaluate data on reviews. Make recommendations for improvements in process or recommendations for program changes or modifications
- Knowledge of Cancer Treatment Medications, indications & AE’s
- Manage medical care in order to return injured employee to preinjury status.
- Assess member’s needs Collaborate with staff, physicians, care/service coordinators, plan Medical Director, members and their families to coordinate and provide the level of care necessary to meet member’s health needs
- Ensure cost effective direct case management services for specialized cases. Communicate with all involved parties to determine client’s (patient’s) status and needs and to coordinate with reinsured health plans and insurance companies
- Works telephonically with workers’ compensation patients, employers, providers, and claims specialists to coordinate and assure proper delivery and oversight of medical and disability services. Initial contacts with all parties is conducted to outline TCM role and set expectations relative to treatment and return to work
- Knowledge of Chronic Disease Treatment Medications, indications & AE’s
- Works cross functionally to identify customer education needs
6
Responsibilities For Nurse Consultant Description Resume
- Identify and communicate customer needs, educational opportunities, and competitive activities through supervisor and internal partners
- Develops goal-focused return-to-work plans
- Addresses barriers for return to work; facilitates communication between employee, physician and employer and partners with all parties to achieve a positive outcome
- Assesses needs, designs, and evaluates the effectiveness of trainings and self-learning materials for public health nursing, as well as other providers who deliver women's and men's reproductive health
- Represents the Section of Public Health Nursing, the Division of Public Health, and the Department of Health and Social Services at conferences, workshops, statewide committees and professional development programs regarding women's and men's reproductive health
- Identifies areas where established protocols, policies or standards of care do not exist or are inadequate or outdated and then researchers best practice, evidence based standards to formulate guidelines, protocols, and policies to meet those needs
- Researches and develops responses for Legislative inquiries, bill analysis, constituent inquiries or correspondence for Department administrators
- Responds to inquiries from the field including public health nurses, nurse practitioners, health aides and members of the public regarding women's and men's reproductive health
- Works with State of Alaska Laboratory Chief and Lab manager to formulate PHN Clinical Laboratory Improvement Amendments (CLIA)-waived testing and Provider-Performed Microscopy procedures to adhere to Center for Disease Control recommendations for "Good Laboratory Practices for Waived Testing" and Provider-Performed Microscopy
7
Responsibilities For Telephonic Nurse Consultant Resume
- Provides clinical safety net to women's and men's reproductive health services and to under-served clients who are not connected with a medical/health care home
- Identifies, recommends, and provides ongoing evaluation of clinical protocols for women's and men's reproductive health services provided primarily by public health nurses across the State. Describes analysis of findings in formal reports, papers, epidemiology bulletins, or presentations as required or requested
- Sound knowledge of public health philosophy, principles, and practices as related to public health with a special focus on population-based individual, community, and system care
- Self-motivated, works independently, completes projects, and works within the team environment
- Knows when to seek consultation and support, and does so as needed
- Provides exceptional customer service to both our SOPHN employees and the communities we serve
- Goes the extra mile to get the job done
- Intermediate computer skills (Windows, MS Office Products, flash drive, data management using folders, import and export functions and the ability to master new technology and complete work electronically)
- Compose technical reports using good grammar
8
Responsibilities For Clinical Adherence Nurse Consultant Rn-telecommute Resume
- Adapt to schedule changes and be willing to travel on short notice
- Work with health care agencies and providers to address and improve maternal morbidity outcomes from such conditions as hemorrhage, pregnancy-induced hypertension, gestational diabetes, postpartum depression, mood disorders in the perinatal period, and obesity
- Research, approve and establish evidence-based best practice standards of clinical care in family planning and related reproductive health, and in women's and men's preventive health services, for health care providers in a variety of health care settings throughout the state
- Utilize novel approaches to provision of education or trainings for professional colleagues, or identify content experts or appropriate programs for specific training needs, and develop self-learning materials and trainings
- Address current health priorities in Perinatal and Women's Health such as oral health for pregnant women; screening and referral for treatment of pregnant and postpartum women for depression; breastfeeding practices beyond six weeks postpartum; and adolescent health visits for teens enrolled in Medicaid
- Multitask, prioritize and effectively adapt to a fast paced, deadline driven environment
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
- Lead the Zika virus prevention activities through training, education and monitoring of virus-positive pregnant women and their infants
- Represent the State as the Women's Health coordinator and collaborate with the regional and national Offices of Women's Health on implementation of women's health initiatives, campaigns, and activities
9
Responsibilities For Nurse Consultant Senior Resume
- Participate in researching and applying for pertinent new funding opportunities and assist in writing clinical aspects of federal grant applications and progress reports as requested
- Independently administer projects related to Perinatal and Adult Preventive Health Services as requested, including budget development and monitoring, and completing required progress reporting on project(s) by required deadlines
- Development, implementation and monitoring of Performance Improvement Projects
- Assist in policy analysis of legislative proposals
- Management of assigned quality committee
- Review of medical records to assess quality of care and documentation of services
10
Responsibilities For Supervisory Nurse Consultant Resume
- Reviews, records, and analyzes medical records and treatment plans data
- Communicates with medical providers and ancillary service providers to negotiate or approve treatment
- Engages physician review agents as appropriate
- Communicates and documents recommendations of treatment to all parties including claims professionals, medical providers, ancillary service providers, employers and employees
- Follows national and state guidelines for approval of treatment , medications, etc
- Gather clinical information and apply the appropriate clinical criteria, 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 and lends expertise to other internal and external constituents in the coordination and administration of the utilization management function
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