Utilization Management Nurse Consultant
New
C
CVS HealthManaged care
Work at Home, New York, United States; Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live., Preference for those residing in Eastern zonesFull-TimeMiddle
Salary$32.01 - $68.55
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Job Details
- Experience
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Required Skills
- Microsoft ExcelPowerPointHIPAA
Requirements
- Have 2+ years of experience as a Registered Nurse in an adult acute care or critical care setting.
- Hold an active, current, unrestricted RN license in the state of residence.
- Have an associate degree; a BSN is preferred.
- Be available for evening, weekend, and holiday shifts, including typically 12 weekend days, one major and one minor holiday, and one 7:00 p.m. shift per month.
- Navigate multiple monitors and applications simultaneously.
- Use Microsoft Office 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar tools such as Google Workspace.
- Use secure systems such as VPNs and EHR portals and follow basic system security practices.
- Meet home-work requirements, including a wired internet connection within 7 feet of the computer with at least 50 Mbps download and 5 Mbps upload; Wi-Fi and satellite internet are not permitted.
- Maintain a quiet, secure, private home workspace compliant with company and HIPAA guidelines.
Responsibilities
- Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
- Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations or recommendations.
- Communicate with providers and other parties to facilitate care and treatment.
- Identify members for referral opportunities to other products, services, or programs.
- Identify opportunities to promote quality and effective healthcare services and benefit utilization.
- Consult with internal and external constituents on utilization and benefit management.
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