Utilization Management RN | Care Coordination & Coverage

CVS Health; Connecticut; Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate, monitor and evaluate options to facilitate healthcare services and benefits for members. You will gather clinical data, apply criteria and render coverage determinations along the care continuum, while collaborating with providers to coordinate care and referrals.

The role emphasizes aligning with policies, ensuring quality, and communicating effectively with internal and external stakeholders in a fast-paced

Qualifications

• Candidate must reside in EST zones.
• Active and unrestricted Registered Nurse (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.

Responsibilities

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• 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.
• Typical office working environment with productivity and quality expectations.
• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
• Sedentary work involving periods of sitting, talking, listening.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written

Skills

RN license

Acute care

Critical care

Weekend hours

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Job description

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate, monitor and evaluate options to facilitate healthcare services and benefits for members. You will gather clinical data, apply criteria and render coverage determinations along the care continuum, while collaborating with providers to coordinate care and referrals.

The role emphasizes aligning with policies, ensuring quality, and communicating effectively with internal and external stakeholders in a fast-paced