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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.
Descriere
- 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.
Cerințe
- 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.
Beneficii
- 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