Clinical Utilization Management Specialist
4 days ago
CVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare 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 and document 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.
- Collaborate with providers and other stakeholders to facilitate care and treatment.
- Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function.
- 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 competitive salary range of $32.01 - $68.55 per hour, as well as a comprehensive benefits package, including medical, dental, and vision coverage, 401(k) retirement savings plan, and employee stock purchase plan. We also offer a fully-paid term life insurance plan, short-term and long-term disability benefits, and a range of well-being programs.
Candidates must be able to work Monday through Friday, 8:30am-5pm or 10:30am-7pm PST. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
We are an equal opportunity and affirmative action employer, committed to diversity and inclusion in the workplace.
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