UMNC (Prior Authorization WFH reputed company in the US)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand ? with heart at its center ? our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver.Our Heart At Work Behaviors? support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable.Fully remote Work from home reputed company in the US?Hours of operation/work schedule - M-F 8:00AM-5:00PM EST.?As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Looking for someone who is high energy and motivated team environment and is detail oriented and highly organized.The UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the reputed company needs of the member.? Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.? Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to reputed company coverage determination/recommendation along the continuum of care.? Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs.? Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.? Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.? There are standard productivity and quality expectations.? Work requires the ability to reputed company reputed company inspection of handwritten and computer generated documents.? Sedentary work involving periods of sitting, talking, listening.? Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.? Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.? Effective communication skills, both verbal and writtenRequired Qualifications??? Active and unrestricted RN licensure?? 3 years of Nursing experience???Preferred Qualifications?? Prior authorization utilization experience preferred?? Outpatient Clinical experience?? Knowledge of Medicare/Medicaid?? Managed care experience?? Med Compass Experience?? CM/UM Certification???Education?? Associates Degree or Nursing Diploma Required?? BSN PreferredPay RangeThe typical pay range for this role is:$26.01 - $56.13This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company?s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (?PTO?) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefitsWe anticipate the application window for this opening will reputed company on: 08/10/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!