Bringing our heart to every moment of your health.
Utilization Management Nurse Consultant
Location
Kansas
Posted
13 hours ago
Salary
$26 - $56 / hour
Seniority
Mid Level
Job Description
Utilization Management Nurse Consultant
CVS Health
• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care • Communicates with providers and other parties to facilitate care/treatment • Identifies members for referral opportunities to integrate with other products, services and/or programs • Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Job Requirements
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Must have active current and unrestricted RN licensure in state of residence
- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
- 2+ years of clinical experience required in med surg or specialty area (preferred)
- Managed Care experience preferred, especially Utilization Management (preferred)
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources based on eligibility
Related Guides
Related Categories
Related Job Pages
More Consultant Jobs
• Assist senior Practice Group consultants with ECM software installations and configurations • Assist senior ECM consultants with data migration tasks and analysis • Create, test, and develop scripts to aid in document management system conversions • Perform ECM system health check and administration activities for our clients • Research new technologies, product features, and industry best practices • Handle and troubleshoot DMS-related support issues submitted by managed Clients
• Responsible for creating new and managing existing relationships in the Independent Registered Investment Adviser channel to increase Jackson Sales in the given territory • Works closely with the VP, RIA Sales to develop an appropriate business plan to maximize territorial sales • Conducts product and sales training through individual and group training sessions, seminars, workshops, and branch meetings • Strategically plans and manages the deployment of resources to maximize territory sales while being responsible for budget and expenses • Works in conjunction with an Internal Wholesaler to identify and foster leads generated from referrals, campaigns, and territory canvassing, and meeting follow-up
• Design and build secure cloud environments and platforms for Allstate. • Automate public cloud services by building continuous integration and delivery pipelines. • Partner with consumers of the cloud platforms to improve feedback and align applications to standards. • Manage complex technical designs in engineering and operating cloud platform infrastructure. • Contribute to strategy and designs for the continuous integration and continuous delivery frameworks and tools.
• Responsible for creating or auditing a comprehensive estimate of damages for 1st and 3rd party material damage claims in either the auto or specialty lines leading to the proper disposition. • Responsible for training, mentoring, controlling quality and providing technical assistance on material damage claims.
