Remote Utilization Management Nurse Consultant

CVS Health Corporation; Springfield (IL); Remoto; USD 44.000 - 95.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Descrizione del lavoro

CVS Health Corporation in Springfield, IL is hiring a Utilization Management Nurse Consultant to assess and coordinate care, applying clinical criteria to determine coverage and benefits for members. This is a 24/7 operation with weekend, holiday and evening hours.

Requirements include 2+ years of RN clinical experience in adult acute/critical care, active RN licensure, and willingness to work varied shifts. A BSN is preferred.

Competenze

• 2+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care setting.
• Must have 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.

Mansioni

• 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.

Conoscenze

Registered Nurse

Clinical experience

Formazione

Associate or Bachelor of Science in Nursing

Strumenti

MS Office

Descrizione del lavoro

CVS Health Corporation in Springfield, IL is hiring a Utilization Management Nurse Consultant to assess and coordinate care, applying clinical criteria to determine coverage and benefits for members. This is a 24/7 operation with weekend, holiday and evening hours.

Requirements include 2+ years of RN clinical experience in adult acute/critical care, active RN licensure, and willingness to work varied shifts. A BSN is preferred.