Utilization Management Nurse Consultant
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About The Position
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours. The role involves utilizing 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. Responsibilities include gathering clinical information, applying clinical criteria/guidelines, communicating with providers, identifying referral opportunities, promoting quality effectiveness of Healthcare Services, and consulting with internal and external constituents in the utilization/benefit management function.
