Current jobs related to Utilization Management Nurse Consultant - Albany - CVS Health

  • Utilization Management Nurse Consultant

    1 month ago

    Albany, United States CVS Pharmacy Full time

    As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the approp Management, Nurse, Consultant, Healthcare, Clinical, Behavioral Health, Retail

  • Clinical Utilization Management Nurse Advisor

    3 weeks ago

    Albany, New York, United States CVS Pharmacy Full time

    Position Overview:As a Clinical Utilization Management Nurse Advisor, your role will involve leveraging your clinical expertise to effectively coordinate, document, and communicate all facets of the utilization and benefit management program.Key Responsibilities:- Ensure that members receive appropriate healthcare services.- Utilize clinical judgment to...

  • Utilization Review Nurse

    6 hours ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Clinical Utilization Nurse

    3 weeks ago

    Albany, United States Albany Medical Center Full time

    Department/Unit: Care Management/Social Work Work Shift: Day Responsibilities: Conduct utilization management and quality screening for assigned patients Apply criteria to monitor appropriateness of admissions and continued stays Identify areas for clinical documentation improvement and facilitate necessary action Monitor length of stay and ancillary...

  • Critical Care Nursing Manager

    1 week ago

    Albany, California, United States Clinical Management Consultants Full time

    Job Summary:Clinical Management Consultants is seeking a seasoned ICU Nurse Manager to lead our team of dedicated healthcare professionals. As a key member of our organization, you will be responsible for overseeing daily operations, ensuring optimal staffing, and promoting high standards of patient care.Key Responsibilities:Lead a team of nurses and support...

  • Material Management Consultant

    2 weeks ago

    Albany, New York, United States LMI Full time

    Position OverviewLMI is in search of an experienced Supply Chain Management Consultant to support the Marine Corps Logistics Command. Our ideal candidate will exhibit proficiency in USMC Intermediate Supply, utilizing systems such as Global Combat Support System - Marine Corps (GCSS-MC) and Navy Enterprise Resource Planning (Navy-ERP). A solid understanding...

  • Utilization Review Nurse Specialist

    1 day ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    3 days ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    1 day ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    3 days ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a Utilization Review Nurse, you will play a critical role in ensuring the efficient use of healthcare resources while maintaining high-quality patient care.Key ResponsibilitiesConduct thorough reviews of patient admissions and continued stays to ensure...

  • Senior Utilization Manager

    3 weeks ago

    Albany, New York, United States TenderHeart Health Outcomes Full time

    Job OverviewTenderheart Health Outcomes stands as the premier provider of Incontinence Management Services across the nation. Our mission is to deliver high-quality products and services that empower individuals to manage their incontinence effectively at home, while simultaneously generating healthcare savings within various managed care sectors.Through our...

  • Travel Nurse RN

    1 week ago

    Albany, Georgia, United States Medical Solutions Full time

    Travel Nurse RN - Case Management (Utilization Review) OpportunityJob Summary:Medical Solutions is seeking a skilled Registered Nurse (RN) to fill a travel job opportunity in Case Management (Utilization Review) in Albany, GA. As a travel nurse with Medical Solutions, you will have the freedom to choose from a variety of assignments nationwide and enjoy...

  • Clinical Utilization Review Nurse

    2 weeks ago

    Albany, New York, United States Albany Medical Center Full time

    Position Overview:As a Clinical Utilization Review Nurse, you will play a vital role in the management of patient care by overseeing Utilization Management, Quality Screening, and Delay Management for designated patients.Key Responsibilities:Conduct Utilization Management and Quality Screening for assigned patients.Utilize MCG criteria to assess the...

  • Senior Operations Utilization Manager

    2 weeks ago

    Albany, New York, United States TenderHeart Health Outcomes Full time

    Job OverviewTenderheart Health Outcomes is proud to have been recognized with the Circle of Excellence award from NBRI for our dedication to quality improvement, reflected in our impressive Net Promoter Score. We are also honored to have been named one of the Top Places to Work in Austin by the Austin American Statesman.We are currently in search of a Senior...

  • Utilization Review Nurse

    4 months ago

    Albany, United States Albany Medical Center Full time

    43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary Range: $31.28 - $51.61 per hour• Completes Utilization Management and Quality Screening for assigned patients.• Applies MCG...

  • Utilization Review Nurse

    1 month ago

    Albany, United States Albany Medical Center Full time

    43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary Range: $31.28 - $51.61 per hour• Completes Utilization Management and Quality Screening for assigned patients.• Applies MCG...

  • Utilization Review Nurse

    4 months ago

    Albany, United States Albany Medical Center Full time

    43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary Range: $31.28 - $51.61 per hour• Completes Utilization Management and Quality Screening for assigned patients.• Applies MCG...

  • Senior Finance Consultant

    3 weeks ago

    Albany, New York, United States Precision Hire Solution Full time

    Job OverviewPrecision Hire Solution is dedicated to fostering a culture that supports both personal and professional development. Our team is at the forefront of transforming the real estate landscape by integrating top-tier services, advisory expertise, and innovative technology for our clients.We are on the lookout for a seasoned Finance Manager with a...

  • Senior Finance Consultant

    3 weeks ago

    Albany, New York, United States Precision Hire Solution Full time

    Job OverviewPrecision Hire Solution is dedicated to fostering both personal and professional growth. Our team is at the forefront of transforming the real estate landscape by integrating top-tier services, consultancy, and innovative technology for our clients.We prioritize attracting the most skilled professionals in the industry and support their...

  • Ecological Consultant

    3 weeks ago

    Albany, New York, United States Hire IT People, Inc Full time

    Position Title: Environmental ScientistLocation: Albany, NY (Hybrid)Contract Duration: 12 MonthsProject Summary:The Environmental Scientist is responsible for applying environmental principles to evaluate and ensure adherence to environmental regulations in Canal operations and construction initiatives. This role requires a comprehensive understanding of...

Utilization Management Nurse Consultant

4 months ago

Albany, United States CVS Health Full time

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

100% remote position
Hours: Monday through Friday, 8am -5pm in time zone of residence
- 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, procedures to render precertification coverage determinations or make recommendations to Medical Directors
- 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 benefit utilization
- Typical office working environment with productivity and quality expectations
- Sedentary work involving periods of sitting, talking, listening
- Work requires sitting for extended periods, talking on the telephone and typing on the computer
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written

**Required Qualifications**
- 3+ years of acute experience as a Registered Nurse
- Must have active current and unrestricted RN licensure in state of residence
- Must be able to work Monday through Friday, 8am to 5pm in time zone of residence
- Must be willing to work holiday rotation per business needs
- MS Office suites experience

**Preferred Qualifications**
- Managed Care experience preferred

**Education**

Associates degree required

BSN preferred

**Pay Range**

The typical pay range for this role is:
$26.01 - $62.31

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.