RN Utilization & Quality Care Consultant (Remote)

CVS Health; Town of King (WI); Presencial; USD 36.000 - 77.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Descripción de la vacante

CVS Health in Wisconsin is seeking a registered nurse to assess, plan, implement, coordinate, and evaluate care options for members. You will work with providers to determine coverage determinations and promote quality care within a collaborative, HIPAA-compliant framework.

Responsibilities include gathering clinical information, applying guidelines, and coordinating with internal teams to integrate benefits. Strong computer skills and multitasking are essential in this full-time, on-site role.

Formación

• Active and unrestricted RN license in their state of residence.
• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• Candidate must be available to work weekends, holidays, and evening hours as required by business needs.

Responsabilidades

• Assess, plan, implement, coordinate, monitor and evaluate care options for members.
• Gather clinical information and apply guidelines to render coverage determinations and recommendations.
• Communicate with providers and other stakeholders to facilitate care and treatment.
• Identify referral opportunities to integrate with CVS Health programs and services.
• Maintain HIPAA-compliant documentation and be proficient with multiple computer systems.

Conocimientos

RN license

2+ years RN experience

Availability for weekends/evenings

Educación

Associates Degree in Nursing

Bachelors Degree in Nursing

Descripción del empleo

CVS Health in Wisconsin is seeking a registered nurse to assess, plan, implement, coordinate, and evaluate care options for members. You will work with providers to determine coverage determinations and promote quality care within a collaborative, HIPAA-compliant framework.

Responsibilities include gathering clinical information, applying guidelines, and coordinating with internal teams to integrate benefits. Strong computer skills and multitasking are essential in this full-time, on-site role.