Remote RN: Utilization Management Specialist

CVS Health; Idaho; Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to coordinate, document and communicate all aspects of the utilization/benefit management program. You will ensure the member receives appropriate care at the right time and place, while adhering to federal and state turnaround times and reviewing clinical records.

This full-time, remote role requires Monday–Friday 8:00am–4:30pm EST and offers comprehensive benefits, eligibility for bonus programs, and opportunities to support

Qualifications

• Active RN licensure in state of residence.
• Available to work Monday–Friday 8:00am–4:30pm EST.
• Willing to work weekend rotation about every 6 weeks.
• Holiday rotation per department need (typically 1 holiday per year).
• 3+ years of clinical RN experience.
• 1+ years experience using Microsoft Office Suite (Teams, Outlook, Word, Excel).
• Preferred: 1+ years Utilization Review or Managed Care experience.
• Must be able to coordinate, document and communicate utilization/benefit management activities.

Responsibilities

• Reviews services to assure medical necessity and appropriate benefit utilization.
• Coordinates, documents and communicates all aspects of utilization/benefit management.
• Assesses, plans, implements and coordinates options to facilitate appropriate healthcare services.
• Gathers clinical information and applies criteria to render coverage determinations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other programs.
• Promotes quality effectiveness of healthcare services and benefit utilization.
• Lends expertise to internal and external stakeholders in utilization/benefit management.

Skills

Strong communication skills

Education

Associate degree

BSN

Tools

Microsoft Office Suite (Teams, Outlook, Word, Excel)

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to coordinate, document and communicate all aspects of the utilization/benefit management program. You will ensure the member receives appropriate care at the right time and place, while adhering to federal and state turnaround times and reviewing clinical records.

This full-time, remote role requires Monday–Friday 8:00am–4:30pm EST and offers comprehensive benefits, eligibility for bonus programs, and opportunities to support