Bringing our heart to every moment of your health.
Utilization Management Nurse Consultant
Location
Tennessee
Posted
2 days ago
Salary
$26 - $68 / 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. • Typical office working environment with productivity and quality expectations • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor • Sedentary work involving periods of sitting, talking, listening • Work requires sitting for extended periods, talking on the telephone and typing on the computer • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding • Effective communication skills, both verbal and written
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, based on eligibility
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