Utilization Management Nurse Consultant

2 days ago

Albany, New York, 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 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.
  • Review written clinical records to ensure medical necessity and apply clinical judgment to assure appropriate benefit utilization.
  • Facilitate safe and efficient discharge planning and work closely with facilities and providers to meet the complex needs of our members.
  • Collaborate with internal and external stakeholders to identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
  • Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements
  • Active current and unrestricted RN licensure in the state of residence.
  • 3+ years of acute hospital clinical experience as an RN, with a preference for medical-surgical and ICU experience.
  • 3+ years' experience with Microsoft Office Suite and ability to navigate multiple computer systems and keyboarding simultaneously.
  • Ability to work Monday through Thursday 8:00am-4:30pm and Friday 8:30am-5:00pm, with occasional weekend and holiday hours.
  • Ability to work evening rotation until 9pm EST, depending on business needs.
Preferred Qualifications
  • 1+ years' experience in Utilization Review.
  • 1+ years' experience in Managed Care.
  • Strong telephonic communication skills.
  • Time-efficient and highly organized.
What We Offer

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also offer numerous well-being programs, education assistance, and free development courses.

As a CVS Health employee, you will have access to a fully-paid term life insurance plan, short-term and long-term disability benefits, and paid time off (PTO) or vacation pay. We are an equal opportunity and affirmative action employer, committed to diversity and inclusion in the workplace.

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