Clinical Nurse Consultant

4 days ago


Bismarck, North Dakota, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Clinical Nurse Consultant to join our team. As a Clinical Nurse Consultant, you will be responsible for reviewing and evaluating clinical information and documentation to ensure compliance with regulatory and accreditation requirements.

Key Responsibilities
  • Review and interpret clinical records and data to apply appropriate clinical criteria and policies
  • Independently coordinate clinical resolution with clinician/MD support as required
  • Evaluate post-service claims for payment based on clinical policies, legislation, regulatory requirements, and plan benefits
  • Accurately apply review requirements to assure case is reviewed according to all company policies and procedures as well as state and federal laws and regulations
Requirements
  • 5+ years of clinical experience required
  • 2+ years of experience as a Registered Nurse
  • Must have active, current and unrestricted RN licensure in state of residence
  • 1+ years of experience using Microsoft Office products, including Outlook and Excel, and previous experience using Internet Explorer and Google Chrome to effectively utilize review resources and conduct reviews
Preferred Qualifications
  • Utilization Management review
  • Managed Care 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 offer numerous well-being programs, education assistance, free development courses, and a CVS store discount.


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