Clinical Utilization Nurse Consultant

CVS Health; Oregon; Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse for Utilization Management in a 24/7 operation in Oregon. The role requires coordinating care, applying criteria, and communicating with providers to determine appropriate coverage and services. Schedules include weekends, holidays, and evenings.

Associates degree required, BSN preferred. Active RN license in state of residence is a must. The position offers comprehensive benefits and opportunities to work from home with strict HIPAA

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• 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.
• Associates Degree required; BSN preferred.
• Preference for PST time zone residents.

Responsibilities

• Utilizes clinical experience and skills to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation.
• Communicates with providers and other parties to facilitate care/treatment and identifies members for referral opportunities.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Confers with internal/external constituents in the coordination and administration of utilization/benefit management.

Skills

Clinical decision making

Communication skills

Multitasking

Education

Associates Degree

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced Registered Nurse for Utilization Management in a 24/7 operation in Oregon. The role requires coordinating care, applying criteria, and communicating with providers to determine appropriate coverage and services. Schedules include weekends, holidays, and evenings.

Associates degree required, BSN preferred. Active RN license in state of residence is a must. The position offers comprehensive benefits and opportunities to work from home with strict HIPAA