Nurse Consultant for Utilization Management
2 weeks ago
As a pivotal member of CVS Health, the Utilization Management Nurse Consultant plays a crucial role in enhancing patient care through effective utilization management strategies. This position is fully remote, allowing for flexibility while maintaining a focus on delivering quality healthcare.
Key Responsibilities:
- Utilize clinical expertise to assess and ensure the medical necessity of services provided to members.
- Coordinate and document all facets of the utilization management program, ensuring compliance with federal and state regulations.
- Engage in collaborative processes to evaluate and implement healthcare options that meet the diverse needs of members.
- Communicate effectively with healthcare providers and stakeholders to facilitate optimal care and treatment pathways.
- Identify opportunities for quality improvement in healthcare services and benefit utilization.
- Provide consultation and support to internal and external parties regarding utilization management processes.
Qualifications:
Required:
- Active and unrestricted RN licensure in Pennsylvania.
- A minimum of three years of clinical experience in an acute care setting, preferably in medical-surgical or ICU.
- Proficiency in Microsoft Office Suite and experience navigating multiple computer systems.
- Availability to work standard hours with occasional evening and weekend shifts as needed.
Preferred:
- Experience in Utilization Review and Managed Care.
- Strong telephonic communication skills and organizational abilities.
- Associate Degree required; BSN preferred.
Compensation and Benefits:
The compensation for this role is competitive and reflects the experience and qualifications of the candidate. CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and various well-being programs. Employees also enjoy paid time off and holiday benefits, ensuring a healthy work-life balance.
CVS Health is committed to fostering an inclusive workplace and is an equal opportunity employer.
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