Remote RN Utilization & Precertification Consultant

CVS Health; Little Rock (AR); À distance; USD 36 000 - 94 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits

Bonus eligible

Résumé du poste

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, plan, coordinate, and evaluate care options for members within a 24/7 Utilization Management operation. The role emphasizes collaboration with providers to facilitate appropriate services and benefits.

The candidate will gather clinical information, apply criteria and guidelines, and render coverage determinations while identifying referral opportunities to integrate with other CVS Health

Qualifications

• ~3+ years RN experience
• Active RN license in state of residence
• ~1+ years Med/Surg experience
• ~1+ years of MS Office experience (Outlook/Teams/Excel)

Responsabilités

• Assess and coordinate care to facilitate appropriate services/benefits.
• Gather clinical data and apply criteria to render coverage determinations.
• Communicate with providers to coordinate care/treatment.
• Identify referral opportunities to integrate with programs.
• Support quality and utilization management initiatives.

Connaissances

Registered Nurse

Microsoft Office

Formation

Associates degree

BSN preferred

Outils

MedCompass

Description du poste

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, plan, coordinate, and evaluate care options for members within a 24/7 Utilization Management operation. The role emphasizes collaboration with providers to facilitate appropriate services and benefits.

The candidate will gather clinical information, apply criteria and guidelines, and render coverage determinations while identifying referral opportunities to integrate with other CVS Health