Utilization Management Nurse Consultant - Concurrent Review (Remote)
Core
Utilization Management Nurse Consultant performing concurrent reviews to determine coverage, discharge planning, and medical necessity for healthcare services.
Role type
Utilization Management Nurse Consultant (Concurrent Review)
Builds
Coverage determinations, discharge plans, and care management referrals for CVS Health members.
Domain
Health Insurance / Utilization Management
Required skills
RN licensure, clinical practice in inpatient settings, critical thinking, evidence-based care, medical necessity criteria, care coordination, triage/crisis support, care management program facilitation
Preferred skills
Managed care/utilization review experience, acute care/critical care experience, discharge planning experience
Technologies
None stated
Responsibilities
Coordinate, document, and communicate aspects of the utilization/benefit management program; consult with internal and external constituents; gather clinical information to render coverage determination/recommendation/discharge planning; evaluate and facilitate appropriate healthcare services/benefits including urgent or emergent interventions; coordinate with providers to facilitate optimal care; identify members for care management programs and facilitate referrals; identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
Seniority
Mid-level, hands-on IC