Clinical Utilization Management Consultant

6 days ago

Salt Lake, Utah, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Clinical Utilization Management 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 and effective care possible.

Key Responsibilities
  • Utilize clinical expertise to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Gather clinical information and apply relevant clinical criteria, guidelines, policies, procedures, and judgment to render determinations and recommendations along the continuum of care.
  • Communicate effectively with providers and other stakeholders to facilitate care and treatment.
  • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
  • Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements
  • 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.
  • Unrestricted RN license in the state of residence, with multi-state/compact privileges and ability to be licensed in all non-compact states.
  • Ability to use a residential broadband service with internet speeds of at least 25 mbps/3mbps to ensure sufficient speed to perform work duties.
Preferred Qualifications
  • 1 year of varied UM experience within an inpatient/outpatient setting, concurrent review, or prior authorization.
  • 1+ years of Managed Care (MCO) experience.
  • 1+ years of demonstrated experience working in a high-volume clinical call center environment.
  • Remote work experience.
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 provide a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs.

As a CVS Health employee, you will have access to a range of development courses, a CVS store discount, and discount programs with participating partners. You will also enjoy paid time off, paid holidays, and sick time consistent with relevant state law and Company policies.

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