Utilization Management Nurse

Collaborate closely with physicians, nurses, social workers, and a wide range of medical and non-medical professionals Assess the member's specific health plan benefits Provide utilization management (UM) services promoting quality, cost-effective outcomes Facilitate outstanding member care using fiscally responsible strategies Perform concurrent review of members admitted to inpatient facilities Requirements Minimum of three (3) years of nursing or behavioral health experience Active, unrestricted Registered Nurse (RN) license, LPC, LMFT, LCSW, or PMHNP credential required Case Manager Certification as accredited by CCMC preferred Thorough knowledge of medical and behavioral health processes, diagnoses, care modalities Understanding of appropriate case management plans Core Competencies Demonstrates expertise in nursing and behavioral health, with a focus on utilization management and case management strategies to ensure quality care and cost-effective outcomes. Holds relevant certifications and licenses to support comprehensive member assessments and care facilitation. Highest-signal resume keywords Registered Nurse (RN) License Case Manager Certification Utilization Management (UM) Behavioral Health Experience Medical Processes Knowledge ATS Optimization Keywords Hard Skills Nursing Experience Behavioral Health Experience Utilization Management Concurrent Review Case Management Plans Soft Skills Collaboration Communication Assessment Skills Certifications & Qualifications Registered Nurse (RN) LPC LMFT LCSW PMHNP Industry Keywords Health Plan Benefits Member Care Cost-Effective Outcomes Medical Professionals Non-Medical Professionals #J-18808-Ljbffr