Utilization Management Nurse Consultant – Medicare Acute Care
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Pennsylvania, Texas, Vermont • 🇺🇸 United States
Visit company websiteSalary
💰 $29 - $62 per hour
Job Level
JuniorMid-Level
About the role
- Schedule is Mon-Fri 8:00 or 8:30 -5:00 PM with one 7:00 PM rotational shift
- 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
- 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
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical assessmentcare coordinationcoverage determinationclinical judgmentutilization managementhealthcare servicesbenefit managementpolicy applicationprocedure adherence
Soft skills
collaborationcommunicationproblem-solvinginterpersonal skills
Certifications
Registered Nurse licensure