Healthcare Utilization Specialist
2 weeks ago
At CVS Health, we are united by a common mission: to bring compassion to every aspect of health care. Our commitment is to provide innovative, human-centered health solutions that adapt to the evolving needs of our communities.
Position Overview
The role of a Healthcare Utilization Specialist is critical in our 24/7 operational environment, which may require flexibility in work hours, including weekends and holidays.
In this position, you will leverage your clinical expertise to engage in a collaborative approach that encompasses assessment, planning, implementation, coordination, monitoring, and evaluation of healthcare services for our members.
Key Responsibilities
1. Gather and analyze clinical data to apply relevant clinical guidelines and policies, ensuring accurate coverage determinations throughout the care continuum.
2. Facilitate communication with healthcare providers and stakeholders to enhance care delivery and treatment options.
3. Identify members who may benefit from additional services and programs, promoting integrated care solutions.
4. Seek opportunities to enhance the quality and efficiency of healthcare services and benefit utilization.
5. Provide expert consultation to internal and external partners regarding utilization and benefit management processes.
Work Environment
This position is primarily office-based, with expectations for productivity and quality. The role involves:
- Close examination of both handwritten and digital documents.
- Prolonged periods of sitting, engaging in verbal communication, and utilizing computer systems.
- The ability to multitask and adapt to a dynamic work environment is essential.
Qualifications
- A minimum of 3 years of experience as a Registered Nurse.
- At least 1 year of clinical experience in acute or post-acute care settings.
- Active and unrestricted RN licensure in your state of residence.
- Ability to obtain necessary licensure within a specified timeframe.
Preferred Qualifications
- 3+ years of clinical experience is preferred.
- Experience in Managed Care is advantageous.
Education Requirements
- An Associate's degree is required; a Bachelor of Science in Nursing (BSN) is preferred.
Compensation and Benefits
The typical pay range for this role is $56.13 per hour. This range reflects the base hourly rate or annual salary for all positions within this job grade. Actual compensation will be influenced by various factors, including experience and education.
In addition to competitive pay, CVS Health offers a comprehensive benefits package, including:
- Medical, dental, and vision coverage.
- 401(k) retirement savings plan and Employee Stock Purchase Plan.
- Fully-paid term life insurance and disability benefits.
- A variety of well-being programs and educational assistance.
- Paid Time Off (PTO) and paid holidays throughout the year.
For more information on our benefits, please refer to our company resources.
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