Idaho State Job Bank is hiring: Utilization Management Nurse Consultant in Boise

Utilization Management Nurse Consultant at CVS Health in Boise, Idaho, United States Job Description 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 Behaviors 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 Utilization Management is a 24/7 operation and work schedules may include weekends, holidays, and evening hours. This Utilization Management (UM) Nurse Consultant role is 100% remote, and the candidate can live in any state, however; preference will be given to those in Pacific Time Zone or willing to work Pacific Time Zone hours. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. + Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. + 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 wit To view full details and how to apply, please login or create a Job Seeker account