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
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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