Clinical Nurse Specialist for Healthcare Optimization

5 days ago


Home, United States CVS Health Full time
Career Overview
CVS Health is a dynamic and patient-centric healthcare organization dedicated to delivering exceptional care experiences. Our team of professionals shares a common purpose: enhancing human-centric healthcare in a rapidly changing world.

Job Summary
This role plays a vital part in our Utilization Management team, responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services and benefits for members. The Clinical Nurse Specialist will utilize clinical experience and skills to facilitate appropriate care options, collaborating with providers and other parties as needed.

Key Responsibilities
* Assess and plan healthcare services/benefits for members, utilizing clinical judgment and expertise* Gather clinical information, applying relevant criteria, guidelines, policies, and procedures* Communicate effectively with providers and other stakeholders to ensure seamless care delivery* Identify opportunities for quality improvement and effective benefit utilization* Collaborate with internal and external constituents to coordinate and administer the utilization management function

Requirements
* 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 acute or post-acute settings* Managed Care experience preferred* Proficiency with computer skills, including navigating multiple systems and keyboarding

Benefits
CVS Health offers a comprehensive compensation package, including a competitive salary range of $$54,880 - $120,180 per year, based on experience and qualifications. Additionally, eligible employees may participate in a CVS Health bonus, commission, or short-term incentive program. A range of medical, dental, and vision benefits are available, as well as a fully-paid term life insurance plan, short-term and long-term disability benefits, and Paid Time Off (PTO) or vacation pay.

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