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*Quality Management Nurse Consultant

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*Quality Management Nurse Consultant

  • Location:

    Woonsocket

  • Sector:

    MRS Nursing

  • Job type:

    Temporary & Contract

  • Salary:

    Negotiable

  • Contact:

    Ma Andrea Allianza

  • Contact email:

    aallianza@medicalrecruitmentstrategies.com

  • Job ref:

    BBBH408137_1668437912

  • Published:

    19 days ago

  • Expiry date:

    2023-02-12

  • Client:

    Medical Recruitment Strategies

Utilizes clinical experience and skills in a collaborative process to assess,plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Gathers clinical information and applies the appropriate clinical criteria/guideline, 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.
Identifies members for referral opportunities to integrate with other products, services and/or programs.

Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.

Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.