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
Missouri
Posted
2 days ago
Salary
$26 - $56 / hour
Seniority
Mid Level
Job Description
Utilization Management Nurse Consultant
CVS Health
• Review clinical information and apply guidelines to make coverage determinations • Collaborate with providers and internal teams to coordinate care • Identify opportunities to enhance quality, efficiency, and member outcomes • Refer members to appropriate programs and services
Job Requirements
- Active, unrestricted RN license in your state of residence
- 2+ years of recent experience in adult acute or critical care
- Strong clinical judgment and multitasking skills
- Associates Degree in Nursing
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Additional resources based on eligibility
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Utilization Management Nurse Consultant
CVS HealthCVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
• 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
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