Utilization Management Clinician

If you have a passion for providing exceptional patient care and helping to improve the health of individuals, then we are looking for you! CVS Health is seeking a motivated and knowledgeable Utilization Management Clinician to join our team. In this role, you will be responsible for helping to ensure that our customers receive the right care, at the right time, while promoting quality outcomes and cost-effective healthcare.To be successful in this role, you will need to have a valid nursing license, and have a minimum of five years of experience in a Utilization Management role. You should also have experience with or knowledge of regulatory and accreditation standards, and be well-versed in medical necessity criteria and reimbursement models. The ideal candidate should be organized, detail-oriented, and have excellent customer service and interpersonal communication skills. If you are looking to make a positive impact in the lives of our customers, then this is the opportunity for you!

Responsibilities:

1. Utilize medical necessity criteria and reimbursement models to ensure that our customers receive the right care, at the right time.
2. Monitor patient care for quality outcomes and cost-effectiveness.
3. Ensure compliance with regulatory and accreditation standards.
4. Provide exceptional patient care and customer service.
5. Develop and maintain relationships with physicians, healthcare providers, and other stakeholders.
6. Monitor utilization of services to ensure that appropriate resources are being used.
7. Collaborate with other departments to ensure that all patient needs are met in a timely and cost-effective manner.
8. Prepare reports, analyze data, and make recommendations for improvement.
9. Maintain up-to-date knowledge of the healthcare industry.
10. Participate in continuing education and training programs.

According to JobzMall, the average salary range for a Utilization Management Clinician is $36,000 to $91,000. The salary range can vary depending on experience, qualifications, and the specific job role. Those with more experience and higher qualifications can expect to earn higher salaries.

CVS Health Corp. engages in the provision of health care services. It operates trough the following segments: Pharmacy Services, Retail or Long Term Care, and Corporate. The Pharmacy Services segment offers pharmacy benefit management solutions. The Retail or Long Term Care segment includes selling of prescription drugs and assortment of general merchandise. The Corporate segment involves in providing management and administrative services.