Utilization review nurse Jobs in Albuquerque, NM

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Position Summary

Fully remote in the USA.

Shift : 12pm-8 : 30pm eastern time.

• Utilizes clinical experience, and skills, in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services / benefits for members.
• Provides triage and crisis support.
• 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 facilitates including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care / treatment.
• Identifies members at risk for poor outcomes and facilitates 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

Required Qualifications

3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic / facility.

Unencumbered Behavioral Health clinical license in the state where they work. Must have one of the following :

LPC, LMSW, LSW, LISW, LMFT, LMHC, LCSW) OR RN with behavioral health experience required.

Must be able to talk on the telephone and type at the same time, this is a queue based position

Preferred Qualifications

Knowledge of mental health and substance abuse disorders.

Managed care / utilization review experience

Crisis intervention skills

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer

Education

Masters Degree in behavioral health profession

RN degree with 3 years of behavioral health experience

Pay Range

The typical pay range for this role is :

54,095.60 - $116,800.00

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.