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Clinical Utilization Management Nurse Consultant
2 months ago
Transforming Healthcare with CVS Health
At CVS Health, we're committed to delivering exceptional patient care and innovative solutions that make healthcare more personal, convenient, and affordable. As a Clinical Utilization Management Nurse Consultant, you'll play a vital role in shaping our mission.
Job Summary
We're seeking a highly skilled and experienced nurse to join our team in a 100% remote position. As a Clinical Utilization Management Nurse Consultant, you'll work closely with our team to apply critical thinking and clinical expertise to authorize procedures and services, ensuring the best possible outcomes for our patients.
Key Responsibilities
- Apply clinical judgment and evidence-based criteria to make informed decisions regarding treatment and services.
- Collaborate with healthcare providers to collect and review clinical information, ensuring accurate and timely authorization of procedures and services.
- Utilize computer skills to navigate multiple systems, including clinical documentation systems.
- Work independently, making thorough and independent decisions using clinical judgment.
- Participate in training and professional development to stay up-to-date on industry best practices and company policies.
Requirements
- 1+ year of experience in utilization management, concurrent review, or prior authorization.
- 5+ years of clinical experience, including acute care, home health, or long-term care.
- 5+ years of demonstrated ability to make thorough, independent decisions using clinical judgment.
- Proficient use of equipment, including phone, computer, and clinical documentation systems.
- Ability to attend training sessions with 100% participation.
- Unrestricted RN license in the state of residence, with multi-state/compact privileges.
Preferred Qualifications
- 1+ year of experience in managed care (MCO).
- 1+ year of experience working in a high-volume clinical call center environment.
Education
Associate's degree in nursing (RN) required, BSN preferred.
Compensation
The typical pay range for this role is $62.31 per hour. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors.
