2 clinical nurse consultant jobs found in Minnetonka, MN

Remote Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests. You will also manage member case history in compliance with established policies and procedures, applying clinical criteria and member coverage. This role involves interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other internal departments. Your attention to detail and clinical judgment will be crucial in determining the medical necessity of post-acute stays, including skilled nursing facilities, acute inpatient rehabilitation, and long-term acute care hospitals. Responsibilities Review and document prior authorization and concurrent stay requests. Manage and evaluate member case history in line with policies and procedures. Interface with members, providers, facilities, medical directors, and...

Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests. You will also manage member case history in compliance with established policies and procedures, applying clinical criteria and member coverage. This role involves interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other internal departments. Your attention to detail and clinical judgment will be crucial in determining the medical necessity of post-acute stays, including skilled nursing facilities, acute inpatient rehabilitation, and long-term acute care hospitals. Responsibilities Review and document prior authorization and concurrent stay requests. Manage and evaluate member case history in line with policies and procedures. Interface with members, providers, facilities, medical directors, and various...