Remote Utilization Management Nurse Consultant (RN)

CVS Health; Oregon; Híbrido; USD 36.000 - 77.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Utilization Management Nurse Consultant (UMNC) for a fully remote role. The incumbent will coordinate, document and communicate all aspects of the utilization/benefit management program to ensure appropriate care, timing and location while adhering to regulatory timelines.

The UMN will review clinical records, collaborate with facilities and providers, and support discharge planning to meet complex member needs.

Formación

• Active, current RN license in state of residence.
• 2+ years of acute hospital RN experience (within past 10 years).
• 1+ years of experience with Microsoft Office (PowerPoint, Excel, Word).
• Willingness to work Monday–Friday 8:00am–4:30pm in the resident time zone.
• Willingness to work weekend and holiday rotation.

Responsabilidades

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Collaborates to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Gathers clinical information and applies criteria to render coverage determinations/recommendations.
• 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 and effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to internal/external constituents in the utilization/benefit management function.

Conocimientos

RN license

Acute hospital RN experience

Microsoft Office

Educación

Associate Degree in Nursing

BSN preferred

Descripción del empleo

CVS Health is seeking a Utilization Management Nurse Consultant (UMNC) for a fully remote role. The incumbent will coordinate, document and communicate all aspects of the utilization/benefit management program to ensure appropriate care, timing and location while adhering to regulatory timelines.

The UMN will review clinical records, collaborate with facilities and providers, and support discharge planning to meet complex member needs.