riate 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
3+ years of experience as a Registered Nurse
Must have active current and unrestricted RN licensure in state of residence
Must possess 1+ years of clinical experience in acute or post acute setting
Must be able to work Monday through Friday 8am to 5pm in time zone of residence
Must be able to work holiday rotation per business needs
Must obtain California RN licensure within 6 months of hire
3+ years of clinical experience preferred
Managed Care experience preferred
Prefer MST/PST time zone
Associates Degree required
The typical pay range for this role is:
$26.01 - $56.13
This 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.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits