Utilization Nurse Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $32 - $69 per hour
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.
Requirements
- 3+ years of experience as an RN
- Active and unrestricted RN licensure in state of residence
- Able to work in multiple IT platforms/systems
- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical assessmentcare coordinationcoverage determinationclinical judgmenthealthcare servicesbenefit utilizationutilization management
Soft Skills
collaborationcommunicationconsultationproblem-solving
Certifications
RN licensure