CVS Health yra Jungtinių Amerikos Valstijų sveikatos priežiūros įmonė, veikianti sveikatos priežiūros paslaugų, sveikatos draudimo, vaistų išmokų administravimo ir mažmeninės prekybos vaistais srityse. Per tokias veiklas kaip „Aetna“ ir „CVS Caremark“ įmonė padeda užtikrinti sveikatos draudimo apsaugą, receptinių vaistų prieinamumą, ligų valdymą, specializuotus vaistus ir vaistų užsakymo paštu paslaugas. Jos vietinės vaistinės ir platesnės priežiūros paslaugos skirtos tam, kad žmonės galėtų patogiau ir prieinamiau gauti būtiną sveikatos priežiūrą. CVS Health sujungia draudimo, vaistinių ir sveikatos priežiūros paslaugas, kad padėtų žmonėms ir bendruomenėms viso jų priežiūros kelio metu.
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.
Aprašymas
- 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.
Reikalavimai
- 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.
Privalumai
- 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.