CVS Health logo
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

Massachusetts

Posted

1 day ago

Salary

$32 - $68 / hour

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

Utilization Management Nurse Consultant

CVS Health

• Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program • Review services to assure medical necessity and appropriate benefit utilization • Facilitate safe and efficient discharge planning • Work closely with facilities and providers to meet the complex needs of the member • Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options for healthcare services/benefits • Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment • Communicate with providers and other parties to facilitate care/treatment • Identify members for referral opportunities and opportunities to promote healthcare service quality effectiveness

Job Requirements

  • RN with active and unrestricted state licensure in state of residence
  • 3+ years of clinical experience as an RN preferably in the following areas: Med/Surg, Telemetry, ICU, Long term care, cardiology and oncology
  • 1+ years’ experience in either Precertification or Utilization Review preferred
  • 1+ years’ experience Managed Care preferred
  • Strong telephonic communication skills
  • 1+ years’ experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook)
  • Ability to exercise independent and sound judgment, strong decision-making skills, and well-developed interpersonal skills
  • Ability to manage multiple priorities, effective organizational and time management skills required

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families

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