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Utilization Management Nurse Consultant

Oak St. Health
  • US
    New York, New York, United States
  • US
    New York, New York, United States

Über

Medicare Precertification Utilization Management Nurse Consultant (Remote) We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Schedule: Monday–Friday, 9:00 AM – 6:00 PM (local time); includes occasional evenings, holidays, and participation in a 24/7 operation. About the Role We're seeking a Registered Nurse (RN) with strong clinical judgment to join our Utilization Management team. In this role, you'll help ensure members receive appropriate, high-quality, and cost-effective care by reviewing clinical information, making coverage determinations, and collaborating with providers and care teams. What You'll Do
Review and assess clinical information using established guidelines and criteria Make coverage determinations across the continuum of care Collaborate with providers and internal partners to coordinate care Identify opportunities to improve care quality and utilization outcomes Refer members to programs and services that support better health outcomes Serve as a clinical resource for internal and external stakeholders
Required Qualifications
Active, unrestricted RN license in state of residence 3+ years of RN experience 1+ year of Med/Surg experience Proficiency with Microsoft Office (Outlook, Teams, Excel) Associate's degree in nursing (BSN preferred)
Preferred Qualifications
Utilization Management or Prior Authorization experience Managed care and/or Medicare experience Experience with MedCompass Ambulatory surgery experience
This is a great opportunity for an RN looking to leverage clinical expertise in a collaborative, non-bedside role that impacts patient care at scale. Anticipated Weekly Hours: 40 Time Type: Full time Pay Range: $26.01 - $68.55 Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. Additional details about available benefits are provided during the application process.
  • New York, New York, United States

Sprachkenntnisse

  • English
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