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CVS Health

CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca

Utilization Management Nurse Consultant

Location

New Jersey

Posted

2 days ago

Salary

$32 - $68 / hour

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

Utilization Management Nurse Consultant

CVS Health

• Utilize 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 • Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care • Communicate with providers and other parties to facilitate care/treatment • Identify members for referral opportunities to integrate with other products, services and/or programs • Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization • Consult and lend 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
  • Managed Care experience preferred, especially Utilization Management
  • Preference for those residing in EST zones

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • other resources

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