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Remote Utilization Management RN (On-Call) – Must live in CO
Implement changes in contract benefits, regulations, and review criteria guidelines for optimal resource management.
Denver
Senior
$42.47-$52.46 USD per hour
3 months ago
CVS Health
Enabling a more transparent, simple health care system
Job is no longer active
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✨ About The Role
- Responsible for assessing and monitoring resource utilization, coordinating outside referrals, and ensuring quality of care for members
- Maintaining compliance with departmental regulations, external laws, and accreditation standards
- Coordinating care with internal and external stakeholders to facilitate high-quality, timely, and cost-effective care and services
- Implementing changes in contract benefits, state and federal regulations, and established review criteria guidelines
- Educating staff, physicians, departments, and members on resource management options to provide high-quality care efficiently
⚡ Requirements
- Three to five years of clinical experience in a healthcare setting, with experience in utilization review, case management, discharge planning, and managed care
- Strong knowledge of policies and procedures related to compliance, ethics, and integrity in healthcare
- Ability to analyze a large volume of data to identify issues and facilitate problem-solving for continuity of care and optimal resource management
- Registered Nurse License in Colorado and preferably an Associate's degree in Nursing
- Experience in hospital settings such as ICU, CCU, or Med/Surg would be beneficial
Remote Utilization Management RN (On-Call) – Must live in CO
Denver
$42.47-$52.46 USD per hour
Registered Nurse
Job is no longer active
About CVS Health
Enabling a more transparent, simple health care system