Clinical Manager
Vynca
Nurse Consultant, Utilization Management
CVS Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Idaho, North Carolina, Oklahoma
Visit company websiteSalary
💰 $26 - $62 per hour
Job Level
Mid-LevelSenior
About the role
- Medicare Complex Spine Precertification Nurse Consultant position: Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
- 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.
Requirements
- 3+ years of experience as a Registered Nurse
- Must have active current and unrestricted RN licensure in state of residence
- 1+ years of Med/Surg experience
- 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
- Must be willing and able to work Monday through Friday, 9:00am to 5:30pm EST with occasional holiday rotation.
- Prior Authorization or Utilization Management experience (preferred)
- Managed care experience (preferred)
- Experience using MedCompass (preferred)
- Ambulatory surgery experience (preferred)
