RN Utilization & Care Coordination Specialist

CVS Health; Bastrop (LA); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members. You will work collaboratively to determine appropriate care across the continuum and support members and providers.

You will review clinical information against guidelines, communicate with providers, identify referral opportunities, and contribute to the utilization management function.

Qualifications

• Active and unrestricted RN license in state of residence.
• 2+ years RN experience in adult acute/critical care.
• Available to work weekends, holidays, and evenings as required.

Responsibilities

• Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits.
• Gathers clinical information and applies criteria to render coverage determinations along the continuum of care.
• Communicates with providers to facilitate care and identifies referral opportunities to integrate with other programs.
• Identifies opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consults with internal/external constituents in utilization/benefit management coordination.

Skills

RN license

Acute care

Weekend/evening shifts

Clinical documentation

Education

Associates Degree in Nursing

Bachelor's Degree in Nursing

Job description

CVS Health is seeking an experienced Registered Nurse to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members. You will work collaboratively to determine appropriate care across the continuum and support members and providers.

You will review clinical information against guidelines, communicate with providers, identify referral opportunities, and contribute to the utilization management function.