Clinical Utilization Management Specialist
3 weeks ago
Bring your expertise to CVS Health, where we're dedicated to delivering enhanced human-centric healthcare. Our purpose is to make healthcare more personal, convenient, and affordable. As a Clinical Utilization Management Specialist, you'll play a critical role in transforming our culture and accelerating innovation.
Job Summary
This fully remote position requires a skilled RN with 3+ years of experience and 1+ year of inpatient hospital experience. You'll work with clinical information, apply guidelines and policies, and communicate with providers to facilitate care and treatment. Your expertise will help identify opportunities to promote quality effectiveness and benefit utilization.
Key Responsibilities
- Assess, plan, implement, coordinate, monitor, and evaluate options for healthcare services and benefits
- Apply clinical criteria, guidelines, policies, and procedures to render coverage determinations and recommendations
- Communicate with providers and other parties to facilitate care and treatment
- Identify opportunities to promote quality effectiveness and benefit utilization
Requirements
- 3+ years of experience as an RN
- 1+ year of inpatient hospital experience
- Active, current, and unrestricted RN licensure in the state of residence
- Able to work in multiple IT platforms and systems
- Must be willing and able to work Monday through Friday, 9:30am to 6:00pm EST, and occasional weekends and holidays
Preferred Qualifications
- Experience working with Medicare and Medicaid populations
- MCG experience
- Managed care experience
- UM Certification
Education
- Associates Degree required
- BSN preferred
Pay Range
The typical pay range for this role is $30.39 - $65.66 per hour. 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.
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