Search jobs > Topeka, KS > Utilization management

Utilization Management Nurse Consultant

CVS Health
Topeka, KS, US
$29,1-$62,31 an hour
Full-time

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.

This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work BehaviorsTM support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary*

  • 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* - 3+ years of experience as a Registered Nurse - Must possess 1+ years of clinical experience in acute or post acute setting - Must have active current and unrestricted RN licensure in state of residence - Must be able to work Monday through Friday, 8am to 5pm in time zone of residence.
  • Must be able to work occasional holiday rotation per business needs - Must be able to obtain CA nursing license within 6 months of hire (paid for by company) *Preferred Qualifications* - 3+ years of clinical experience preferred - Managed Care experience preferred *Education* Associates degree required BSN preferred *Pay Range* The typical pay range for this role is : $29.

10 - $62.31This 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 jobs.CVSHealth.com / benefits (https : / / jobs.cvshealth.

com / benefits) We anticipate the application window for this opening will close on : 04 / 23 / 2024

24 days ago
Related jobs
CVS Health
Topeka, Kansas

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, p...

CVS Health
Topeka, Kansas

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 fo...

Promoted
Levi Hunter
Topeka, Kansas

Proficiency in project planning, execution, monitoring, and closure techniques, including the use of project management software tools like MS Project and SharePoint, is essential for effectively overseeing project timelines, resources, and deliverables. A Project Manager is responsible for the init...

Promoted
AdventHealth
Topeka, Kansas

Registered Nurse Cardiology Clinic -. Received Magnet® recognition from the American Nurses Credentialing Center in January 2019. The RN, under the direction of the Practice Manager/Clinical Supervisor, provides nursing care to patients and assists with patient education. The RN is able to handle th...

Promoted
UKHS St. Francis Campus
Topeka, Kansas

The Registered Nurse functions under the direction of the Nurse Director/Manager and is responsible for coordination of safe patient care delivery for specified and diverse patient populations. Join our team as a day shift, full time, Nuerology Clinic Registered Nurse in Topeka, Kansas. The RN Adher...

Promoted
Fresenius Medical Care
Topeka, Kansas

The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). Performs all essential functions under the direction of the Supervisor and with guidance from the Clinical Educator, Preceptor or in collaboration with other Registered Nu...

Promoted
Klaton Consultants
Topeka, Kansas

The Resource Nurse will work with the ED and RCC in communities to assist with task completion of items such as: quarterly pharmacy reviews, Risk Watch, admissions/re-admissions, labs (routine draw, review completion, and documented results, PCP notification and new orders, in-house physician visits...

Promoted
Recover-Care Healthcare
Topeka, Kansas

Registered Nurse RN $5000 Sign-On Bonus. We are looking for the best Registered Nurse (RNs) to provide exceptional care to our residents. Certification as a Registered Nurse (RN). As a Registered Nurse (RN) you are responsible for providing exceptional nursing care in accordance with our policies an...

Promoted
Intermountain Health
Topeka, Kansas

Job Description:The goal of the Clinical Documentation Specialist-Auditor is to improve the accuracy of the overall clinical picture and the representation of the complexity and severity of illness of patients through improved clinical documentation and diagnostic coding practices.Job EssentialsRevi...

Promoted
Truhealth LLC
Topeka, Kansas

TruHealth is seeking an advanced practice provider, either a nurse practitioner (NP) or physician assistant (PA) with experience in primary care or internal medicine, preferably with geriatrics focus. If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who enjoy...