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UMNC at CVS Health - ApplyBlast

UMNC

CVS Health

3 months ago

3.2 on Glassdoor

California

Onsite

Full Time

Junior

0 applicants

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About this role

A Utilization Management Nurse at CVS Health assesses and coordinates healthcare services to ensure appropriate coverage and quality care for members. The role involves applying clinical guidelines to render coverage determinations, consulting with providers, and managing care options within a 24/7 operation. This position requires leveraging acute care nursing experience to optimize benefit utilization and integrate members with various health programs.

Responsibilities

Assess and coordinate appropriate healthcare services for members
Apply clinical criteria to render coverage determinations
Communicate with providers to facilitate treatment plans
Identify opportunities to promote quality effectiveness of services
Consult expertise in coordination of utilization management functions

Skills

Qualifications

Registered Nurse LicenseAssociates DegreeBSN PreferredUnrestricted RN LicensureClinical Experience in Med Surg Area

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.