Utilization Management Nurse Consultant

CVS Health•Work At Home-Florida, FL

3d•$29 - $62•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Requirements

Registered Nurse
Diploma RN acceptable; Associate degree/BSN preferred
3+ years of experience as a Registered Nurse
1+ years of clinical experience in acute or post-acute setting
1+ years of Utilization Management / Care Management Experience
Must have active current and unrestricted RN licensure in state of residence.
May be required to obtain additional Nursing Licenses as business needs require.
Effective verbal and written communication skills.
Proficiency with computer skills, including navigating multiple systems and keyboarding.
Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
Capacity to sit for extended periods, talk on the telephone, and type on the computer.

Nice To Haves

Utilization Management experience preferred

Responsibilities

Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care.
Communicate with providers and other parties to facilitate care and treatment.
Identify members for referral opportunities to integrate with other products, services, or benefit programs.
Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Meet set productivity and quality expectations as established by UMNC.