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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

South Carolina

Posted

17 days ago

Salary

$26 - $56 / hour

Seniority

Mid Level

Associate Degree2 yrs expEnglish

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
  • Associates Degree required, BSN preferred

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • comprehensive benefits package

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