Utilization Management Nurse Consultant – Concurrent Review

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🔥 51 minutes ago

🦀 Maryland – Remote

🦀 Maryland – Remote

💵 $26 - $74 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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• Just posted.
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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Coordinate, document and communicate all aspects of the utilization/benefit management program • Apply critical thinking, clinical knowledge, evidence-based care and medical necessity criteria to support appropriate service utilization • Consult with and provide expertise to internal and external constituents on utilization/benefit management • Gather clinical information and apply medical necessity criteria, policies, procedures and clinical judgment to render coverage determinations, recommendations and discharge planning • Evaluate and facilitate appropriate healthcare services and benefits for members, including urgent or emergent interventions such as triage and crisis support • Coordinate and communicate with providers and other parties to facilitate optimal care and treatment • Identify members who may benefit from care management programs and facilitate referrals • Identify opportunities to promote quality and effective healthcare services and benefit utilization

🎯 Requirements

• RN with compact licensure required, with ability to obtain additional licenses as needed • RN with unrestricted state licensure required • Willingness to obtain additional state licenses • 3+ years of clinical practice experience in an inpatient setting required • Ability to work rotating weekends • AA Nursing required • Managed care/utilization review experience preferred • Acute care/critical care experience preferred • Discharge planning experience preferred • BSN preferred • Work four ten-hour shifts in EST, with rotating days off, rotating on-call weekends and holidays

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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