Utilization Management Nurse Consultant
| Company | CVS Health |
|---|---|
| Location | Pennsylvania, USA, Delaware, USA, Jackson Township, NJ, USA, Florida, USA, South Carolina, USA, Georgia, USA, Virginia, USA, Rhode Island, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, North Carolina, USA |
| Salary | $34.92 – $74.78 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level |
Requirements
- Must have active, current and unrestricted RN licensure in New Jersey or Compact RN License
- 3+ years of clinical experience
- 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
Responsibilities
- Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification
- The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers
- Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed
Preferred Qualifications
- Previous prior authorization experience
- Prior experience working for a health plan