Utilization Management Nurse Consultant

CVS Health
Washington, District of Columbia, United States
Full Time
Remote
Mid
USD 66,581 – 142,584
Associate Degree
Healthcare Healthcare Life Sciences

Posted 1 week ago

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Excellent 4.7

Job summary

The Utilization Management Nurse Consultant evaluates healthcare services to ensure appropriate care and benefits for members. They assess clinical information, apply guidelines, communicate with providers, and promote quality healthcare utilization. The role requires clinical judgment, computer skills, and ability to work in a fast-paced environment, often remotely.

Responsibilities

The Utilization Management Nurse Consultant assesses, plans, and coordinates healthcare services to ensure appropriate benefit utilization for members. They apply clinical criteria and guidelines to render coverage determinations while communicating with providers to facilitate effective care.

Qualifications

Clinical assessment Communication skills Computer proficiency Critical thinking EHR system use Healthcare services Medical coding Medical terminology Microsoft Office 365 System navigation

Candidates must have at least 2 years of experience as a Registered Nurse in an adult acute or critical care setting and hold an active, unrestricted RN license. Proficiency in computer systems and the ability to work a 24/7 schedule including weekends and holidays are required.

English

Benefits

  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs

Company

CVS Health

CVS Health

linkedin
Hospitals and Health Care
Location
Washington, District of Columbia, United States

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Excellent 4.7
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