Clinical Utilization Management Specialist

4 days ago


Sacramento, California, United States CVS Health Full time
Job Summary

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.
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 an acute or post-acute setting.
  • Ability to work a 24/7 operation, including weekends and holidays, and evening rotations.
Preferred Qualifications
  • 3+ years of clinical experience.
  • Managed Care experience.
What We Offer

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.



  • Sacramento, California, United States Universal Health Services Full time

    Job SummaryWe are seeking a highly skilled Clinical Utilization Management Specialist to join our team at Universal Health Services. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring the optimal utilization of healthcare resources while promoting positive patient outcomes.Key ResponsibilitiesTimely Clinical...


  • Sacramento, California, United States CVS Health Full time

    Job SummaryCVS 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 ResponsibilitiesUtilize clinical expertise to coordinate, document, and...


  • Sacramento, California, United States Universal Health Services Full time

    Job Title: Clinical Utilization ManagerAt Universal Health Services, we are seeking a highly skilled Clinical Utilization Manager to join our team. As a key member of our multidisciplinary treatment team, you will play a critical role in promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews,...


  • Sacramento, California, United States Universal Health Services Full time

    Job Title: Clinical Utilization ManagerHeritage Oaks Hospital, part of the Universal Health Services (UHS) family, is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our multidisciplinary treatment team, you will play a vital role in ensuring optimal patient care and reimbursement.Responsibilities:Conduct daily clinical...


  • Sacramento, California, United States Universal Health Services Full time

    Job Title: Utilization Management CoordinatorAt Heritage Oaks Hospital, we are seeking a highly skilled Utilization Management Coordinator to join our team. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring that our patients receive the highest level of care while promoting positive outcomes and optimal...


  • Sacramento, California, United States Universal Health Services, Inc. Full time

    Job SummaryHeritage Oaks Hospital, part of the UHS Family of Providers, is seeking a skilled Utilization Management Coordinator to facilitate a continuum of service while promoting positive outcomes and optimal reimbursement. As a key member of the multidisciplinary treatment team, you will educate and guide on level of care requirements and payer...


  • Sacramento, California, United States Universal Health Services Full time

    Job SummaryWe are seeking a highly skilled Utilization Management Coordinator to join our team at Sierra Vista Hospital. As a key member of our Utilization Management Department, you will play a critical role in ensuring the effective management of patient resources and maximizing the quality of care.ResponsibilitiesManage and review patient utilization of...

  • Clinical Specialist

    2 weeks ago


    Sacramento, California, United States Boston Scientific Full time

    About the RoleThe Clinical Specialist will be responsible for providing clinical product assistance to surgeons and surgical teams, with a focus on the safe and effective use of medical devices. This role will involve training and supporting surgical teams in the use of these devices, as well as providing clinical support for physician training and sales...


  • Sacramento, California, United States Sierra Vista Hospital Full time

    Job SummarySierra Vista Hospital is seeking a skilled Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a vital role in ensuring the efficient use of resources and maximizing patient care.ResponsibilitiesManage and review patient records to ensure clinical appropriateness and maximize...


  • Sacramento, California, United States Universal Health Services Full time

    Job Title: Utilization Management CoordinatorSierra Vista Hospital is seeking a dedicated and experienced Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a vital role in ensuring the effective management of patient resources and maximizing the quality of care.Responsibilities:Manage...

  • Clinical Specialist

    4 weeks ago


    Sacramento, California, United States Accordance Search Group Full time

    Job Summary:The Clinical Specialist will be responsible for providing clinical case coverage and training to the surgical team on the safe and effective use of medical devices. This role requires a strong understanding of minimally invasive spine procedures and the ability to develop technical acumen to serve as an educational and clinical resource.Key...


  • Sacramento, California, United States Sierra Vista Hospital Full time

    Job Title: Utilization Management CoordinatorAbout the Role:Sierra Vista Hospital is seeking a highly skilled Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a critical role in ensuring the effective management of patient resources and maximizing the quality of...

  • Clinical Specialist

    2 weeks ago


    Sacramento, California, United States accordance search group Full time

    Job OverviewWe are seeking a highly skilled Clinical Specialist to join our team at Accordance Search Group. As a Clinical Specialist, you will play a critical role in providing clinical case coverage and training to the surgical team on the safe and effective use of our medical devices.Key ResponsibilitiesProvide clinical case coverage as assigned, ensuring...

  • Clinical Specialist

    4 weeks ago


    Sacramento, California, United States Accordance Search Group Full time

    Job Summary:The Clinical Specialist will be responsible for providing clinical case coverage and training to the surgical team on the safe and effective use of medical devices. This role requires a strong understanding of minimally invasive spine procedures and the ability to develop technical acumen to serve as an educational and clinical resource.Key...

  • Clinical Specialist

    3 weeks ago


    Sacramento, California, United States Boston Scientific Full time

    About the RoleThe Clinical Specialist will be responsible for providing clinical product assistance to surgeons and surgical teams, training them on the safe and effective use of medical devices. This role will involve covering Intracept cases in the territory, region, or nation, as assigned, and providing clinical support for physician training and sales...


  • Sacramento, California, United States CVS Health Full time

    Job SummaryCVS 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 ResponsibilitiesUtilize clinical expertise to assess, plan,...


  • Sacramento, California, United States CVS Health Full time

    Job SummaryCVS 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 ResponsibilitiesUtilize clinical expertise to coordinate, document,...


  • Sacramento, California, United States CVS Health Full time

    Job SummaryCVS 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 vital role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate and document all aspects...


  • Sacramento, California, United States CVS Health Full time

    Job SummaryCVS 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 vital role in ensuring that our members receive the most appropriate care at the right time and in the right location.Key ResponsibilitiesUtilize clinical expertise to coordinate and document all aspects...

  • Clinical Specialist

    4 weeks ago


    Sacramento, California, United States Boston Scientific Full time

    About the RoleThe Clinical Specialist will independently cover Intracept cases, providing training to the surgical team on the safe and effective use of the device. This role will cover Intracept cases in the territory, region, or at times the nation, as assigned. The Clinical Specialist will work with the surgical team to provide clinical product assistance...