Utilization Nurse Consultant
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Utilization Nurse Consultant at CVS Health utilizing clinical experience to facilitate appropriate healthcare services and coordinate member care. Join us in building a compassionate health experience.
Responsibilities:
- 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.
Requirements:
- 3+ years of experience as an RN
- Active and unrestricted RN licensure in state of residence
- Able to work in multiple IT platforms/systems
- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
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
Similar Jobs
Managed Application Services Consultant
Managed Application Services Consultant at Evotix supporting clients in optimizing their EHS software. Collaborating with teams to ensure smooth application performance and enhancing customer solutions.
Principal Business Solution Consultant
Customer Solution Consultant at CSG focusing on telecommunications to deliver innovative solutions. Engage with clients to align strategic goals with CSG solutions.
Student Admissions Consultant – Bildungsberatung, Kundenbetreuung
Student Admissions Consultant at StartSteps guiding prospective students through admissions for online tech programs. Responsible for support and relationship building with public institutions.
Global Travel Consultant
Global Travel Consultant designing unforgettable escapes for adventure-seeking clients. Remote work opportunity with flexible schedule and no experience needed.
Global Travel Consultant
Global Travel Consultant working remotely to design unforgettable travel experiences for clients. No experience needed, just passion and bold energy for adventure.
Global Travel Consultant
Global Travel Consultant at Affinity Travels, designing unforgettable travel experiences for clients. Passion-driven role allowing for remote work and flexible schedules.
Energy Consultant
Independent Partner helping households save on everyday bills by introducing essential services like energy and broadband. Flexible self-employed role with training and support.
Technical PS Consultant
Professional Services Consultant responsible for driving customer success and effective Barista platform implementations. Collaborates with customers on requirements and guides deployment for optimal experience.
Technical PS Consultant
Professional Services Consultant ensuring successful implementations of Barista solutions. Partnering with customers to translate requirements into practical solutions and improve employee experience.
Clinical Consultant – Xper IM, Enterprise Informatics
Clinical Consultant optimizing healthcare IT solutions with Xper Hemodynamics. Assisting in training, workflow assessments, and customer support with a focus on clinical impact.
Senior Archiving & ILM Consultant
Senior Archiving & ILM Consultant specializing in SAP solutions, analyzing requirements and implementing concepts for data archiving.
Business Coach, Consultant – Exit Strategy
Business Coach assisting small to mid-sized businesses in increasing profit and value for sale. Engaging with clients through 1:1 consulting based on proprietary Exit Factor method.
Senior Consultant – Dynamics 365 F&SCM, Manufacturing
Join Argano as a Dynamics 365 F&SCM – Manufacturing Senior Consultant. Drive impactful solutions by collaborating with clients to optimize their business processes.
Consultant
Consultant at Argano, LLC devising methods for identifying data patterns and trends. Implementing Anaplan and mentoring junior team members in data integration and visualization.
Senior EAM Consultant – S/4HANA, Cloud, Innovation
Senior EAM Consultant driving SAP S/4HANA projects and innovative solutions in a digital environment at Evora IT Solutions.
Senior Media Consultant
Media Consultant creating 360° media strategies for clients. Covering analysis, implementation, and budget management for effective campaigns.
Energy Billing Consultant – m/f/d
SAP Consultant for the energy sector creating innovative solutions and optimizing billing processes. Joining a strong team and engaging in exciting SAP projects.
Tax Assistant, Consultant
Steuerassistent:in managing strategic tax consulting for clients including companies and wealthy individuals. Collaborating with tax experts on financial planning and legal frameworks.
Senior PS Consultant
Senior PS Consultant providing technical support for custom applications built on Genesys Cloud. Collaborating with customers for troubleshooting and implementation activities.
Professional Product Data Consultant – m/f/d
Product Data Consultant ensuring high-quality, scalable product data at INSPORT Digital GmbH. Collaborating with content, IT, and external partners to automate product data processes.