Welcome to CVS Health, where our mission is to help people on their path to better health. We are looking for a highly motivated and experienced Utilization Management Nurse Consultant to join our team. In this role, you will have the opportunity to collaborate with healthcare providers and insurance companies to ensure cost-effective and quality care for our patients. As a valued member of our… organization, you will play a critical role in driving positive outcomes and promoting optimal healthcare utilization. If you have a passion for improving patient care and possess the necessary qualifications, we encourage you to apply for this exciting opportunity.
Collaborate with healthcare providers and insurance companies to review and assess utilization of healthcare services for patients.
Conduct thorough and timely reviews of medical records to determine the appropriateness and necessity of procedures, treatments, and medications.
Analyze data to identify trends and patterns in healthcare utilization and make recommendations for improvement.
Communicate with patients, providers, and insurance companies to educate and inform on utilization management processes and decisions.
Work with interdisciplinary teams to develop and implement utilization management strategies and protocols.
Utilize evidence-based guidelines and clinical knowledge to make informed decisions on the most appropriate and cost-effective care for patients.
Monitor and track utilization management outcomes and provide regular reports to management.
Identify opportunities for cost savings and improvement in healthcare utilization.
Stay up-to-date on industry trends, regulations, and best practices related to healthcare utilization management.
Serve as a resource and consultant for colleagues and healthcare providers on utilization management processes and procedures.
Maintain accurate and detailed documentation of utilization management activities.
Uphold CVS Health’s mission to help people on their path to better health through promoting optimal healthcare utilization.
Adhere to all ethical and legal standards in conducting utilization management activities.
CVS Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics
