CVS Health je ameriško zdravstveno podjetje, ki deluje na področju zdravstvenih storitev, zdravstvenega zavarovanja, upravljanja lekarniških ugodnosti in maloprodajnih lekarn. Prek podjetij, kot sta Aetna in CVS Caremark, podpira zdravstveno kritje, dostop do zdravil na recept, obvladovanje zdravstvenih stanj, specializirana zdravila in lekarniške storitve naročanja po pošti. Njegove lokalne lekarne in širša ponudba zdravstvene oskrbe so zasnovane tako, da ljudem omogočajo udobnejši in cenovno dostopnejši dostop do nujno potrebne zdravstvene oskrbe. CVS Health združuje zavarovanje, lekarniške in zdravstvene storitve ter tako podpira posameznike in skupnosti skozi celotno pot njihove zdravstvene oskrbe.
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.
Opis
- 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.
Zahteve
- 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.
Ugodnosti
- 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.