CVS Health

Compensation

Full Description

Job Description: • Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of healthcare resources • Conducts routine utilization reviews and assessments, applying evidence-based criteria and clinical knowledge to evaluate the medical necessity and appropriateness of requested healthcare services • Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare professionals by promoting effective utilization management strategies • Consults with and provides expertise to other internal and external constituents throughout the coordination and administration of the utilization/benefit management function • Communicates regularly with internal and external stakeholders to facilitate effective care coordination, address utilization management inquiries, and ensure optimal patient outcomes Requirements: • Registered Nurse (RN), preferably in a compact state • 3-5 years Prior Relevant Work Experience • Working knowledge of problem solving and decision making skills • Working knowledge of medical terminology • Working knowledge of digital literacy skills • Ability to deal tactfully with customers and community • Ability to handle sensitive information ethically and responsibly Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access • Many other benefits depending on eligibility