Utilization Management Nurse Consultant
4 weeks ago
CVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our clinical team, you will be responsible for reviewing and evaluating clinical information and documentation to ensure that our members receive the best possible care.
Key Responsibilities:
- Review and evaluate clinical information and documentation to ensure compliance with regulatory and accreditation requirements
- Apply clinical decision-making skills to interpret data and make informed decisions about member care
- Collaborate with clinicians and other stakeholders to coordinate care and resolve issues
- Act as a resource for customer service and claims processing areas
- Utilize clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
Requirements:
- 2+ years of clinical experience as an RN in an acute or post-acute setting
- Active, current, and unrestricted RN licensure in the state of residence
- 1+ years of experience using Microsoft Office products, including Teams, Outlook, and Excel
- Ability to work Monday through Friday, 8am to 5pm in the time zone of residence
Preferred Qualifications:
- Experience with CEC, MedCompass, HRP, IOP, or claims/clinical review experience
- Experience working with adults and/or pediatrics outpatient therapy
- Experience working in a multidisciplinary team
What We Offer:
- A competitive salary range of $26.01 - $56.14
- A comprehensive benefits package, including medical, dental, and vision benefits
- A 401(k) retirement savings plan and an Employee Stock Purchase Plan
- A fully-paid term life insurance plan and short-term and long-term disability benefits
- Well-being programs, education assistance, and free development courses
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