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Remote Utilization Management RN (On-Call) – Must live in CO

Implement changes in contract benefits, state and federal regulations, and established review criteria guidelines.
Denver
Senior
$42.47-$52.46 USD per hour
3 weeks ago
CVS Health

CVS Health

Enabling a more transparent, simple health care system

✨ About The Role

- Responsible for assessing and monitoring resource utilization, coordinating outside referrals, and ensuring quality of care for members - Maintaining compliance with departmental policies, procedures, regulatory requirements, and accreditation standards - Managing appropriate levels of care and services based on clinical knowledge, guidelines, and physician consultation - Analyzing data related to member benefits, eligibility, facilities, contracts, and clinical status to facilitate continuity of care and quality service - Educating staff, physicians, departments, and members on resource management options for high-quality and efficient care
- Experienced healthcare professional with 5-8 years of clinical experience in a healthcare setting, preferably in utilization review, case management, discharge planning, and managed care - Strong knowledge of compliance, ethics, and integrity in healthcare practices - Ability to analyze and synthesize large volumes of data to identify issues and facilitate problem-solving for optimal patient care and resource management - Registered Nurse License in Colorado with additional certifications preferred - Excellent communication skills to coordinate care with internal and external stakeholders effectively
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Remote Utilization Management RN (On-Call) – Must live in CO
Denver
$42.47-$52.46 USD per hour
Registered Nurse
About CVS Health
Enabling a more transparent, simple health care system