Utilization Management Nurse Consultant – Compact RN License Required
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
- Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
- Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
- Identifies members who may benefit from care management programs and facilitates referral
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Requirements
- 3+ years of clinical practice experience in an inpatient setting required
- Must have active current and unrestricted RN licensure (Must have a compact license OR a New Jersey RN License)
- Willingness to obtain additional state licenses as needed (paid for by company)
- Previous Utilization Management and/or Managed Care experience preferred
- Discharge planning experience
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
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and 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 & Tools
clinical skillscritical thinkingevidence-based caremedical necessity criteriadischarge planningcare managementutilization managementhealthcare services evaluationtriagecrisis support
Soft Skills
communicationcollaborationcoordinationinterpersonal skillsproblem-solvingorganizational skillsconsultationfacilitationquality improvementdecision-making
Certifications
RN licensurecompact licenseNew Jersey RN License