Utilization Management Nurse Consultant

CVS Health
Arizona, United States
Full Time
Remote
Mid
USD 60,528 – 129,626
Associate Degree
Healthcare Healthcare Life Sciences

Posted 4 days ago

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Excellent 4.7

Job summary

The Utilization Management Nurse Consultant reviews clinical cases, collaborates with providers, and makes coverage decisions to ensure members receive appropriate care in a non-bedside, remote setting.

Responsibilities

Review clinical cases and make coverage determinations using evidence-based criteria while collaborating with interdisciplinary teams. Identify opportunities to improve quality, outcomes, and member experience through clinical judgment and prior authorization decisions.

Qualifications

ambulatory surgery Care Management clinical assessment critical thinking decision-making MedCompass or similar UM platforms Medical-Surgical Nursing Microsoft Office Prior Authorization utilization management

Requires an active, unrestricted RN license and a minimum of 3 years of RN experience, including at least 1 year in Medical-Surgical nursing. Candidates must possess an Associate Degree in Nursing and proficiency in Microsoft Office applications.

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
Arizona, United States

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Excellent 4.7
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