Utilization Management Clinical Nurse Consultant – Licensed in Arizona

Job not on LinkedIn

7 hours ago

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

💵 $26 - $74 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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CVS Health

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Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program • Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function • Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care • Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members • Coordinates and communicates with providers and other parties to facilitate optimal care/treatment • Identifies members who may benefit from care management programs or other post-discharge programs and facilitates referrals • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

🎯 Requirements

• 3+ years of experience in acute hospital clinical practice • Must have active and unrestricted RN (Registered Nurse) Licensure in the state of Arizona, or Compact RN licensure • Ability to work Monday-Friday from 8:30am-5:00pm, Arizona Time Zone

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access and many other benefits depending on eligibility