利用管理护士顾问
Utilization Management Nurse Consultant
职位名称：利用管理护士顾问
工作地点：南卡罗来纳州，美国，居家办公
工作地点类型：远程
工作合同类型：全职
职位级别：
我们正在打造一个围绕每个人的健康世界，塑造更加互联、便捷和富有同理心的健康体验。在CVS Health®，您将与充满热情的同事一起工作，他们深怀关怀，有目的性地创新，对自己负责，并在每件事中优先考虑安全和质量。加入我们，成为更大事业的一部分——帮助简化医疗保健，一次一个人、一个家庭和一个社区。
职位概述
利用管理是一个24小时运作的部门，工作时间将包括周末、节假日和晚上。
- 利用临床经验和技能，在协作过程中评估、计划、实施、协调、监控和评估选项，以促进成员的适当医疗服务/福利。
- 收集临床信息并应用适当的临床标准/指南、政策、程序和临床判断，以做出覆盖范围的决定/建议，贯穿整个护理过程
- 与提供者和其他方沟通，以促进护理/治疗。识别成员以推荐机会，与其他产品、服务和/或项目整合
- 识别促进医疗服务和福利使用的质量和效率的机会
- 为内部和外部相关方在协调和管理利用/福利功能方面提供咨询和专业知识
- 典型的办公室工作环境，有生产力和质量期望
- 工作需要能够仔细检查手写和计算机生成的文件以及电脑显示器
- 静坐工作，包括坐着、说话和倾听的时间段
- 工作需要长时间坐着，打电话和在电脑上打字。能够多任务处理、优先排序并有效适应快节奏的变化环境
- 要求具备计算机技能，包括在多个系统中导航和键盘输入
- 有效的沟通技巧，包括口头和书面表达
所需资格
2年以上在成人急性护理/重症监护环境中的注册护士经验
- 必须在居住州持有有效且无限制的注册护士执照
- 利用管理是一个24/7的岗位
查看英文原文
Job Title: Utilization Management Nurse Consultant
Job Location: Work at Home, South Carolina, United States
Job Location Type: Remote
Job Contract Type: Full time
Job Seniority Level:
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
- 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 render 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.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
- 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 written
Required Qualifications
2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Must have active current and unrestricted RN licensure in state of residence
- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
Preferred Qualifications
- 2+ years of clinical experience required in med surg or specialty area
- Managed Care experience preferred, especially Utilization Management
- Preference for those residing in ET zones
Education
Associates Degree required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $56.14This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/19/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Originally posted on Himalayas