Utilization Management Nurse: Care Coordination Expert

CVS Health; Salem (OR); Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking a registered nurse to support utilization management in a 24/7 operation. The role involves assessing, planning and coordinating care, applying clinical criteria, and communicating with providers to ensure appropriate benefits and services for members.

Candidates will have 2+ years of RN experience in adult acute/critical care, Active RN licensure, and flexibility to work weekends, holidays and evenings. A 40-hour work week is typical.

Qualifications

• 2+ years of RN experience in adult acute/critical care
• Active, unrestricted RN licensure in the state of residence
• Utilization Management operates 24/7 with weekends/holidays/evening hours

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gather clinical information and apply criteria/guidelines to render coverage determinations
• Communicate with providers to facilitate care and identify referral opportunities
• Identify opportunities to promote quality, effectiveness of healthcare services and benefit utilization
• Collaborate with internal/external stakeholders in utilization/benefit management

Skills

RN licensure

Clinical experience

Communication skills

24/7 schedule readiness

Education

Associate degree

BSN preferred

Job description

CVS Health is seeking a registered nurse to support utilization management in a 24/7 operation. The role involves assessing, planning and coordinating care, applying clinical criteria, and communicating with providers to ensure appropriate benefits and services for members.

Candidates will have 2+ years of RN experience in adult acute/critical care, Active RN licensure, and flexibility to work weekends, holidays and evenings. A 40-hour work week is typical.