Skip to contentUtilization Management Nurse Consultant
| Company | CVS Health |
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| Location | New York, NY, USA |
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| Salary | $32.01 – $68.55 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Junior, Mid Level |
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Requirements
- Registered Nurse with active and unrestricted New York state licensure
- 1+ year of Utilization review experience
- 1+ year of clinical experience
Responsibilities
- Utilizes MCG rules and applies medical necessity guidelines to service requests
- Works closely with leadership and Medical Director on member requests
- Ensures that service requests are addressed timely and within specific allowable turnaround times
Preferred Qualifications
- Managed Care or Managed Long Term Care experience
- Prior Authorizations
- Medicaid and Medicare Processes
