Utilization Management Nurse Consultant

Are you a highly skilled nurse looking for a new and exciting opportunity to use your expertise and make a meaningful impact? Look no further! CVS Health is seeking a Utilization Management Nurse Consultant to join our team and help us provide the best care and support to our members. As a leader in the healthcare industry, we are committed to improving the health and well-being of our patients. In this role, you will utilize your clinical knowledge and critical thinking skills to review and evaluate medical records and collaborate with providers to ensure the most appropriate and cost-effective care is being delivered. If you have a passion for helping others and a desire to be a part of a dynamic and innovative company, we want to hear from you!

1. Review and evaluate medical records to determine the most appropriate and cost-effective care for patients.
2. Collaborate with healthcare providers to ensure the delivery of high-quality and evidence-based care.
3. Utilize clinical knowledge and critical thinking skills to identify any potential gaps in care and recommend appropriate interventions.
4. Maintain a thorough understanding of insurance policies, guidelines, and regulations related to utilization management.
5. Serve as a resource to healthcare providers and members, providing guidance and education on utilization management processes.
6. Communicate with members and providers to gather necessary information and address any concerns or questions.
7. Document all utilization management activities accurately and efficiently.
8. Participate in team meetings and provide insights and recommendations to improve the utilization management process.
9. Stay up-to-date on industry trends and advancements in healthcare to continuously improve utilization management practices.
10. Adhere to all company policies and procedures and maintain confidentiality of patient information.
11. Collaborate with other departments and teams within the company to ensure a seamless and efficient utilization management process.
12. Serve as a positive and professional representative of the company, promoting our commitment to improving patient health and well-being.
13. Continuously seek opportunities for professional development and growth to enhance skills and knowledge in the field of utilization management.

According to JobzMall, the average salary range for a Utilization Management Nurse Consultant is $67,000 to $94,000 per year. This can vary depending on location, experience, and employer. Utilization Management Nurse Consultants are registered nurses who specialize in managing and optimizing healthcare resources for patients. They work closely with healthcare providers, insurance companies, and patients to ensure that medical procedures and treatments are necessary, appropriate, and cost-effective.

In addition to their base salary,

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.