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Position Summary
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours.
This is a fulltime remote Utilization Management opportunity.
- 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
- Must reside in EST zone
- 3+ years of clinical experience as a Registered Nurse in a hospital setting including Medical/Surgical, Emergency room, Critical Care, ICU, and/or stepdown unit
- Must have active current and unrestricted RN licensure in state of residence
- Must possess 1+ years of clinical experience in acute or post-acute setting
- Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations.
- Candidates must be able to work Monday-Friday, 8:00am-5:00pm in time zone of work being supported. A rotation to 10:30am-7pm may be required in time zone of work being supported
Preferred Qualifications
- Utilization review experience
- Medicare experience
- Managed Care experience
Proficiency with computer skills which includes navigating multiple systems and keyboarding
Education
- Minimum of an Associate’s Degree in Nursing required
- BSN preferred
Pay Range
The typical pay range for this role is:
$26.01 – $56.14
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 11/16/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.