Business Coach/Consultant, Exit Strategy
Exit Factor
Nurse Consultant, Utilization Management
CVS Health
full-time
Posted on:
Location: Idaho, North Carolina, Oklahoma • 🇺🇸 United States
Visit company websiteSalary
💰 $29 - $62 per hour
Job Level
JuniorMid-Level
About the role
- 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
- Work schedules will include weekends, holidays, and evening hours
- Typical office working environment with productivity and quality expectations; sedentary work involving periods of sitting, talking, listening
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
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
- Associates Degree required
- BSN preferred
- 2+ years of clinical experience required in med surg or specialty area (preferred)
- Managed Care experience preferred, especially Utilization Management
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- Ability to perform close inspection of hand written and computer generated documents as well as a PC monitor
