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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 months ago
✨ 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
⚡ Requirements
- 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
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