Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Typical office working environment with productivity and quality expectations.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written
Required Qualifications
– 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
– Must have active current and unrestricted RN licensure in state of residence
– Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
Preferred Qualifications
– 2+ years of clinical experience required in med surg or specialty area
– Managed Care experience preferred, especially Utilization Management
– Preference for those residing in MNT or CST
Education
– Associates Degree in Nursing required
– Bachelors in Science and Nursing preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$29.10 – $62.32
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
SPECIALTIES:
Utilization Review & Management (UR/UM)
