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Utilization Management Nurse Consultant
4 weeks ago
CVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.
Key Responsibilities- Utilize clinical expertise to coordinate, document, and communicate all aspects of the utilization/benefit management program.
- Ensure that members receive the most appropriate care at the right time and in the right setting, while adhering to federal and state regulated turn-around times.
- Review written clinical records and apply clinical judgment to render coverage determination/recommendations.
- Collaborate with providers and other parties to facilitate care and treatment.
- Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
- 3+ years of experience as a Registered Nurse.
- Active current and unrestricted RN licensure in the state of residence.
- 1+ years of clinical experience in an acute or post-acute setting.
- Ability to work a 24/7 operation, including weekends and holidays, and evening rotations.
- 3+ years of clinical experience.
- Managed Care experience.
CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, as well as a 401(k) retirement savings plan and an Employee Stock Purchase Plan. We also offer numerous well-being programs, education assistance, and a CVS store discount.
As a CVS Health employee, you will have access to a range of benefits and perks, including paid time off, paid holidays, and a fully-paid term life insurance plan. We are an equal opportunity and affirmative action employer, and we do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
