Clinical Nurse Consultant
2 weeks 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 vital role in ensuring that our members receive the highest quality care while minimizing healthcare costs.
Key Responsibilities- Conduct thorough assessments of member needs and benefit plan eligibility to facilitate integrative functions and smooth transitions to Aetna programs and plans.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers, and address complex health and social indicators that impact care planning and resolution of member issues.
- Assess member's level of work capacity and related restrictions/limitations, and utilize a holistic approach to determine the need for referrals to clinical resources.
- Collaborate with supervisor and others to overcome barriers in meeting goals and objectives, and present cases at case conferences for multidisciplinary focus to benefit overall claim management.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Active, current, and unrestricted RN state licensure in state of residence, preferably compact.
- 3+ years of clinical practice experience as an RN required.
- Ability to work Monday through Friday 8:00 AM to 4:30 PM local time with evening rotation required about 2 times a month until 8pm, EST.
- 2+ years of experience using Microsoft Office Suite applications (Teams, Outlook, Word, Excel, etc.).
- Ability to organize, multitask, prioritize, and work in a fast-paced environment.
- BSN preferred.
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 provide a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs. Eligible employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
About CVS HealthCVS Health is a leading healthcare company that puts its heart into caring for our colleagues and our communities. We are committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose guides our commitment to innovation and excellence in everything we do.
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Clinical Nurse Consultant
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Albany, New York, United States CVS Health Full timeJob 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 highest quality care while minimizing healthcare costs.Key ResponsibilitiesConduct thorough assessments of members' medical needs and develop...
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