Nurse Consultant Job Description

Nurse Consultant Job Description

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Nurse consultant provides oversight, guidance, and training to partner providers and clinicians related to CMS guidelines and HCC best practices.

Nurse Consultant Duties & Responsibilities

To write an effective nurse consultant job description, begin by listing detailed duties, responsibilities and expectations. We have included nurse consultant job description templates that you can modify and use.

Sample responsibilities for this position include:

Receive weekly sets of medical records
Pull new information
Notify complaint analysts in order for the complaint file to be update for Med Watch submission to FDA
Become familiar with complaint database
Assesses organizational structure and processes needed to achieve quality patient outcomes
Facilitates, leads or participates in organizational / departmental assessments of nursing practice and organization
Produces timely and comprehensive written reports and other deliverables
Reviews existing policies, procedures, organizational charts, committee charters, plans, and similar documents and makes recommendations for revisions/improvements
Assists, facilitates and supports the development of strategic plans and action plans that may be required to improve upon existing processes or the design of new processes to achieve objectives identified by the organization
Assists, facilitates and supports activities to ensure that standards of care, policies and procedures are evidence-based, current and applicable to treatment setting and scope of the organization’s services

Nurse Consultant Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Nurse Consultant

List any licenses or certifications required by the position: CIC, IP, CRC, OCN, BLS, ACLS, CPR

Education for Nurse Consultant

Typically a job would require a certain level of education.

Employers hiring for the nurse consultant job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in School of Nursing, Nursing, Education, Health, Associates, Medical, Ethics, Infectious Diseases, Teaching, Supervision

Skills for Nurse Consultant

Desired skills for nurse consultant include:

Guidelines and national standards of practice
Managed care with emphasis on use of criteria
Medicare market
CMS HCC Model and Guidelines along with ICD 10 Guidelines
Products and competitors
Hematology/oncology market
Related disease states and the ability to serve as a technical and clinical resource to the medical community
Complex delegation arrangements
Contracts
Benefit plan structure

Desired experience for nurse consultant includes:

Assists, facilitates, and supports activities to ensure that standards of practice and competency requirements are applicable to treatment setting and scope of the organization’s services, that staff have the knowledge and skills to meet the organization and program expectations in assigned span of control
Facilitates, leads, or participates in educational program development and implementation where needed to support safe patient care practice within a nursing practice setting, and/or within a general practice setting involving a collaborative team
Assists with, facilitates and supports the implementation and evaluation of programs such as Administrative Patient Safety Rounds
Works with organizations to develop/foster a climate of mutual understanding and appreciation of cross-cultural differences inherent in a multicultural society exemplifying the organization’s Service Excellence philosophy
Assist with and works to improve aspects of service excellence within an organization at all levels and across the clinical and nonclinical environments
Supports, facilitates and assists in assessment/development/implementation/improvement of aspects of a Quality program where key performance measurements are required, and where a risk management program is in place or needed to support the patient safety program of a facility which aims to meet internationally accepted standards from a management and clinical perspective, meeting the regulatory norms required for the organization

Nurse Consultant Examples

1

Nurse Consultant Job Description

Job Description Example
Our company is hiring for a nurse consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for nurse consultant
  • Manages assigned caseload of complex cases
  • To work independently, managing a caseload and reporting to registered manager
  • Initial assessment of potential clients care needs,needs, and through to the formulation of the care plan
  • Ensure all clients have up to date care plans that are accessible to the whole team and provide the standard of care expected of the company
  • On-going assessment, coordination and management of the care package
  • Inclusive regular communication with the wider MDT
  • Reviewing of documentation
  • Monitoring the delivery of care
  • Teaching and assessing of skills for care staff
  • Work with patients/clients who have a range of clinical needs
Qualifications for nurse consultant
  • Must have Utilization Review experience from a provider
  • 2-3 years or more of Managed Care experience
  • Prior Authorization Utilization Review experience
  • A competitive basic salary which goes hand in hand with a monthly branch related bonus
  • Attendance to company clinical forums to support and develop your nursing career
  • Flexible working with opportunity to work from home
2

Nurse Consultant Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of nurse consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for nurse consultant
  • Evaluates and coordinates medical diagnostic and rehabilitative services using cost containment programs and strategies
  • Review medical records, question compensability and create medical action plans/strategies that result in claim resolution
  • Provide medical oversight on both financially and medically catastrophic claims
  • Use creativity and innovation to ensure medical treatment is medically necessary and appropriate, facilitate return to work and ultimately claim resolution
  • Coordinate and provide medical oversight to field case managers
  • Ability to read, speak, and write in both English and Spanish proficiently is preferred
  • Bachelor’s Degree & licensed as a Registered Nurse required
  • Strong clinical background in orthopedics or ICU preferred
  • Two years of workers’ compensation experience, preferably work comp coordination or case management required
  • Must have a natural curiosity for the medical facts of a file
Qualifications for nurse consultant
  • Experience conducting Minimum Data Set (MDS) assessments
  • 5+ years of clinical experience in varied settings
  • Certified Case Manager or NCQA
  • 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
3

Nurse Consultant Job Description

Job Description Example
Our innovative and growing company is hiring for a nurse consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for nurse consultant
  • In response to inquiries, provides NHSN user support regarding procedures for correctly applying CDC HAI definitions and criteria and data entry
  • Assists/leads the development of new NHSN modules, providing subject matter expertise related to HAI surveillance
  • Identifies and creates necessary NHSN module/manual updates resulting from technological advancements, infection/disease trends, changing or broadening IP/nursing RESPONSIBILITIES or yearly updates of system components (International Classification of Diseases 9th Revision Clinical Modifications [ICD-9-CM])
  • W orks with appropriate CDC staff to provide the infection preventionist (IP)/nursing perspective related to HAI policy and guideline development
  • Provides consultation and technical assistance to national infection prevention/nursing organizations in order to support their HAI prevention/control activities and to promote DHQP policies and initiatives
  • Reviews current published literature on HAI IP/nursing-related issues and notifies appropriate staff when new significant developments or issues appear
  • Perform clinical claim administration tasks within departmental metrics such as prescribed turn-around time, documentation, qualitative, quantitative, and customer service
  • Measure case management intervention to determine outcomes to include clinical, financial, quality of life, and customer satisfaction
  • Provides performance improvement consulting services clinical oversight to assigned facility
  • Provides JCAHO and Regulatory support
Qualifications for nurse consultant
  • Consults and lends expertise to other internal and external constituents in the coordination and administration of the
  • Utilization/benefit management function
  • An active and good standing Registered Nurse (RN) license in the state of Virginia is required
  • 3-5+ years of clinical experience as a Registered Nurse (RN) required
  • 1-3+ years of direct or related managed care experience (Utilization Management, Case Management, Discharge Planning, Concurrent Review, ) required
  • Responsible for review of claims and underwriting prospects and renewals for cost savings opportunities in the Stop-Loss department utilizing extensive knowledge, expertise and experience
4

Nurse Consultant Job Description

Job Description Example
Our company is hiring for a nurse consultant. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for nurse consultant
  • Uses appropriate tools and techniques to analyze and present data
  • Addresses barriers for return to work
  • Deliver high quality, on site, clinical nursing services
  • Perform incident investigation on selected incidents which require nursing expertise
  • Deliver ergonomic assessments and ergonomic solution recommendations
  • Deliver travel health consultation in collaboration with NP/PAs, physicians, and in accordance with EHS Work Instructions and Medical Directives
  • Phlebotomy services for diagnostic testing
  • Develop, maintain and deliver compliance with EHS Work Instructions and quality assurance processes
  • Providing leadership to policy-making committees and task forces to plan, design, implement and modify quality and performance goals consistent with compliance with pre-established criteria
  • Identifying trends and utilization of VA Portland Health Care System services and monitoring patient care plans for outcomes and case management needs
Qualifications for nurse consultant
  • Registered Nurse with professional approach and ability to work independently, essential
  • An in-depth knowledge of the Case Management process with, and an RN with at least 5 years’ clinical experience
  • Knowledge of Stop Loss with the ability to interpret policy language preferred
  • Must be able to utilize reference materials and comprehend medical terminology
  • Strong professional relationship building skills
  • Must have strong analytical, organization and decision making skills and a business orientation
5

Nurse Consultant Job Description

Job Description Example
Our innovative and growing company is hiring for a nurse consultant. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for nurse consultant
  • Consulting with clinicians and conducting interviews
  • Analyzing and integrating program financial, technical, procurement, and scheduling information
  • Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs
  • Work collaboratively with the other members of the care team
  • Travel throughout the United States to provide orientations and consultation to Nursing School faculty
  • Position will be responsible for actively managing and determining medical necessity of acute and sub-acute inpatient admissions utilizing clinical criteria for Commercial and Medicare membership
  • Position will be actively involved in managing cases with the input from Plan Medical Directors and will participate in regularly scheduled rounds with Medical Directors
  • Medical reviews of inpatient acute hospitalizations
  • Assistance with discharge planning
  • Discussion with medical directors on complex cases
Qualifications for nurse consultant
  • Successful completion of an accredited college level lactation certification program that includes 300 hours or more of precepted clinical lactation experience may be substituted for years of prior experience
  • Must be computer literate to navigate through internal and external computer systems
  • Must be able to exercise independent and sound judgment in clinical decision making
  • Organizational skills, effective time management and ability to manage multiple priorities are a must
  • Managed care or utilization management experience preferred
  • Previous marketing analysis, budgeting and business development experience is desired

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