Utilization Management Nurse Consultant
| Company | CVS Health |
|---|---|
| Location | Washington, USA, Oregon, USA, Nevada, USA, Idaho, USA |
| Salary | $29.1 – $62.32 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level, Senior |
Requirements
- Must reside in the PST zone
- Must have active current and unrestricted RN licensure in state of residence
- 3+ years of experience as a Registered Nurse
- 1+ years of clinical experience in acute or post acute setting
- Willing and able to work Monday through Friday 8:00am to 5:00pm PST with weekend, evening, and holiday rotations
Responsibilities
- 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.
Preferred Qualifications
- Utilization review experience
- Managed Care experience