CVS Health ir Amerikas Savienoto Valstu veselības aprūpes uzņēmums, kas darbojas veselības aprūpes pakalpojumu, veselības apdrošināšanas, aptieku pabalstu pārvaldības un mazumtirdzniecības aptieku jomā. Ar tādiem uzņēmumiem kā Aetna un CVS Caremark tas atbalsta veselības apdrošināšanas segumu, recepšu medikamentu pieejamību, veselības stāvokļa pārvaldību, specializētus medikamentus un medikamentu pasūtīšanu pa pastu. Uzņēmuma apkārtnes aptiekas un plašāki aprūpes pakalpojumi ir veidoti, lai cilvēki varētu ērtāk un izdevīgāk saņemt būtiski nepieciešamo veselības aprūpi. CVS Health apvieno apdrošināšanu, aptieku un veselības aprūpes pakalpojumus, lai atbalstītu cilvēkus un kopienas visā viņu aprūpes ceļā.
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.
Apraksts
- 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.
Prasības
- 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.
Priekšrocības
- 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.