Nurse Consultant

Job Description

Skills:

• Proficient in Word.
• Interqual experience preferred.

Essential Duties and Responsibilities:

• Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations and project requirements.
• Draft clinical summaries for medical review in accordance with applicable regulations and project requirements.
• Render medical necessity determinations for assigned cases.
• Resolve all other technical issues within reconsideration assigned.
• Review medical records, cases or sites assigned to determine and summarize facts and assess any issues identified.
• Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
• Perform other duties as assigned by management.