Utilization Management Nurse Consultant

at  CVS Health

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours.

POSITION SUMMARY

• 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

REQUIRED QUALIFICATIONS

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• Must possess 1+ years of clinical experience in acute or post acute setting

PREFERRED QUALIFICATIONS

• Managed Care experience preferred

EDUCATION

Associates Degree required
BSN preferred

Please refer the Job description for details