Lifelancer जीवन विज्ञान, फार्मास्यूटिकल और आईटी क्षेत्रों पर केंद्रित एआई-संचालित प्रतिभा भर्ती मंच है। यह कुशल पेशेवरों को अपना अनुभव प्रस्तुत करने, अंतरराष्ट्रीय नौकरियों और परियोजना अवसरों की खोज करने तथा विशेष प्रतिभा की तलाश कर रहे नियोक्ताओं से जुड़ने में मदद करता है। भर्ती टीमों के लिए, Lifelancer एआई-सहायता प्राप्त प्रतिभा खोज को कई देशों में भर्ती और पेरोल संबंधी सहायता के साथ जोड़ता है, जिसमें अनुपालन संबंधी विचार भी शामिल हैं।
Utilization Management Nurse Consultant
Review clinical information and coordinate coverage decisions for CVS Health members. This remote Illinois role supports a 24/7 utilization management operation.
विवरण
- Evaluate care options to help members receive appropriate healthcare services and benefits.
- Review clinical information and use established criteria, policies, procedures, and professional judgment to make or recommend coverage decisions.
- Coordinate care and treatment by communicating with providers and other parties.
- Identify members who may benefit from referrals to other products, services, or programs.
- Find ways to improve the quality and effective use of healthcare services and benefits.
- Advise internal and external stakeholders on coordinating and administering utilization and benefit management.
- Work in a 24/7 operation, which may include evenings, weekends, and holidays.
- Perform duties that require extended sitting, phone and computer use, and close review of documents and screens.
- Use multiple applications and systems while meeting productivity and quality standards.
आवश्यकताएँ
- At least 2 years of clinical experience as a registered nurse in a hospital adult acute care or critical care setting.
- Current, active, unrestricted RN license in the state of residence.
- Associate or bachelor’s degree in nursing; a BSN is preferred.
- Preferred: at least 3 years of clinical experience in adult medical-surgical nursing or a specialty area.
- Managed care experience preferred, particularly in utilization management.
- Candidates based in the Central time zone are preferred.
- A direct, wired internet connection to the modem or router within 7 feet of the computer.
- Internet service with at least 25 Mbps download and 3 Mbps upload speeds.
- Wi-Fi and satellite internet are not permitted.
- A quiet, secure, private home workspace that meets CVS Health and HIPAA guidelines.
- Ability to work within the state and city of current residence.
- Proficiency using multiple systems and keyboarding.
- Strong verbal and written communication skills.
- Experience with, or ability to use, Microsoft Office 365 or similar productivity tools.
- Ability to access secure systems such as VPNs and electronic health record portals.
- Ability to maintain strong passwords and identify suspicious emails or links.
- Ability to resolve common technical issues and contact IT when needed.
- Willingness to learn new workplace skills.
लाभ
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Resources for physical, emotional, and financial well-being
- Company-provided equipment, such as a keyboard, monitor, computer, and headset
- Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay
- Flexible work-from-home arrangement