Data Coordinator – Trauma, Burn, and Injury Prevention
Children's Mercy Kansas City
Nurse Consultant – Utilization Management
CVS Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Montana, North Carolina, Virginia
Visit company websiteSalary
💰 $29 - $62 per hour
Job Level
JuniorMid-Level
About the role
- Utilizes clinical experience and skills to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
- Gathers clinical information and applies 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
- Sedentary work involving periods of sitting, talking, listening; ability to perform close inspection of documents and PC monitor
Requirements
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- 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 in med surg or specialty area (preferred)
- Managed Care experience preferred, especially Utilization Management
- Proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written
- Ability to multitask, prioritize and adapt to a fast paced changing environment
