- Specialty: Utilization Review
- Job type: Full-time
- Salary: $26 – $69 / hr
- License states: Any US
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At a glance
100% remote RN utilization management role at CVS Health. Reviews clinical records to assure medical necessity and appropriate benefit utilization using designated criteria, coordinating with facilities and providers. Requires an active unrestricted RN license, 3+ years acute hospital experience, and an associate's deg
This Utilization Management Nurse Consultant (UMNC) position is 100% remote.
As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program and our plan sponsor(s). You would be responsible for ensuring the member is receiving the appropriate care, at the appropriate time, and at the appropriate location using designated criteria, while adhering to federal and state regulated turn-around times. This includes reviewing written and electronic clinical records. We are looking for someone who is highly motivated, detail-oriented, highly organized, and works well in a team environment.
Through the use of clinical tools and information/data review, the UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning, and works closely with facilities and providers to meet complex needs of the member.
Associate’s Degree Required
BSN preferred
40
Full time
$29.10 - $62.32
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