Nurse Consultant for Utilization Management
2 weeks ago
At CVS Health, we are dedicated to enhancing the health and well-being of our communities. Our mission is to provide personalized health care solutions that meet the evolving needs of our members.
Position Summary
This role requires residency within a specified distance from the office location. Initial training will be conducted in a designated office, followed by a remote work arrangement with occasional in-office requirements.
Key Responsibilities
As a Precertification Nurse, you will:
- Conduct telephonic assessments to evaluate members' medical needs and facilitate their overall wellness.
- Implement and coordinate case management activities in alignment with clinical coverage policies.
- Utilize clinical tools and data analysis to assess members' needs and eligibility for benefits.
- Employ clinical judgment to address health risks and barriers affecting care planning.
- Review prior claims to identify impacts on current case management.
- Collaborate with multidisciplinary teams to enhance claim management outcomes.
Qualifications
Required:
- Active and unrestricted RN state licensure.
- A minimum of three years of clinical nursing experience.
- Proficiency in Microsoft Office Suite.
- Ability to work designated hours with occasional evening shifts.
Preferred:
- Strong organizational and multitasking skills.
- Experience in a fast-paced healthcare environment.
Education
An Associate's degree is required; a Bachelor of Science in Nursing is preferred.
Compensation and Benefits
We offer a competitive pay range along with a comprehensive benefits package, including medical, dental, and vision coverage, retirement savings plans, and various well-being programs. Employees also enjoy paid time off and holiday benefits.
Diversity and Inclusion
CVS Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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