CVS Health एक अमेरिकी स्वास्थ्य सेवा कंपनी है, जो स्वास्थ्य सेवाओं, स्वास्थ्य बीमा, फार्मेसी लाभ प्रबंधन और रिटेल फार्मेसी के क्षेत्रों में काम करती है। Aetna और CVS Caremark जैसे व्यवसायों के माध्यम से यह स्वास्थ्य कवरेज, दवाओं तक पहुंच, रोग प्रबंधन, विशेष दवाओं और मेल-ऑर्डर फार्मेसी सेवाओं में सहायता प्रदान करती है। इसकी स्थानीय फार्मेसियां और व्यापक स्वास्थ्य सेवाएं लोगों को आवश्यक स्वास्थ्य देखभाल अधिक सुविधाजनक और किफायती तरीके से प्राप्त करने में मदद करने के लिए बनाई गई हैं। CVS Health बीमा, फार्मेसी और स्वास्थ्य सेवाओं को एक साथ लाकर लोगों और समुदायों को उनकी स्वास्थ्य यात्रा के दौरान सहयोग प्रदान करती है।
Remote Utilization Management Nurse Consultant
Provide remote clinical review for CVS Health’s Medicare coverage decisions. Apply medical criteria, coordinate care, and help ensure appropriate member benefits.
विवरण
- Assess and coordinate options for appropriate healthcare services and benefits using clinical experience.
- Review clinical information and apply criteria, guidelines, policies, procedures, and judgment to make or recommend coverage decisions.
- Work with providers and other parties to support care and treatment.
- Identify members who may benefit from referrals to other products, services, or programs.
- Spot ways to improve healthcare service quality and effective use of benefits.
- Advise internal and external partners on coordinating and administering utilization and benefit management.
आवश्यकताएँ
- At least 3 years of experience as a registered nurse.
- An active, current, unrestricted RN license in the state of residence.
- At least 1 year of medical-surgical experience.
- At least 1 year of experience with Microsoft Office applications, including Outlook, Teams, and Excel.
- Able and willing to work Monday through Friday, 9:00 a.m. to 5:30 p.m. Eastern or Central Time, with occasional holiday rotation.
- Available for holidays and evening hours as Utilization Management operates around the clock.
- Prior authorization or utilization management experience preferred.
- Managed care experience preferred.
- Experience with MedCompass preferred.
- Ambulatory surgery experience preferred.
- Associate degree required.
- BSN preferred.
लाभ
- Medical coverage.
- Dental coverage.
- Vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs.
- Resources supporting physical, emotional, and financial well-being.
- Eligibility for CVS Health bonus, commission, or short-term incentive programs.