Utilization Review Consultant and Coordinator

A regional healthcare organization overseeing 11 ambulatory sites in the Pacific Northwest has a need in Utilization Review Management.

This is an opportunity to develop a complete proposal for an internal healthcare Utilization Review Management function. Begin in a consulting role for a minimum period of 6 months investigating and reviewing the overall scope of resources, internal and external, to determine the infrastructure required. The role transitions from consulting into a permanent position at the end of that period.

Utilization Review Discovery and Analysis

Summary of the discovery and analysis phase functions anticipated to achieve with this Utilization Management (UM) resource are noted below:

• Patient risk classification using data from external claims, Emergency Room admits, pre-authorizations, hospital census and their EPIC system,
• Tracking and reporting consolidated UM statistics from multiple sources,
• Formulate UM guidelines, complex care management workflows and team structure in line with our managed care strategy,
• UM coordination and integration with plans, hospitals, clinics and other care delivery systems to avoid duplication of services,
• Patient tracking and monitoring,
• Internal UM reviews, and
• Evaluate UM effectiveness.

Education and Experience

Registered Nurse with 3 to 5 years Utilization Review Management experience preferably with some consulting background and understanding of managed care delivery systems.

Compensation and Relocation

Based on hourly consulting rate for first six months then salary range of $80K TO $90K per year.
Lodging is provided during consultant phase.
Good relocation assistance both for consulting and future permanent role.

Is this the next step in your career?

Please contact Sam Buster by phone 800-970-4218 or apply for this, or other opportunities in Utilization Management.

Healthcare and Nurse Executives | Hospital Directors | Hospital Leadership Teams
Clinical Nurse Leader | Nurse Practitioners | Physician Assistants

We work on a strictly confidential basis. We do not disclose your name or forward your resume to anyone without your prior approval.

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