We are seeking a compassionate and skilled Registered Nurse to join our team in a pivotal role focused on ensuring the delivery of high-quality healthcare services to our members. In this position, you will collaborate with a multidisciplinary team to assess, plan, implement, and monitor healthcare options tailored to meet individual member needs.
Key Responsibilities:
Utilize clinical expertise to evaluate and coordinate healthcare services for members, ensuring optimal benefits utilization.
Analyze reports to identify trends and issues, providing valuable insights for continuous improvement.
Serve as the primary point of contact for frontline staff, offering guidance and support on complex cases.
Participate in RN/MD rounds as needed and assist with escalated case reviews and facility issues.
Apply clinical criteria, guidelines, and judgment to make coverage determinations and recommendations across the care continuum.
Facilitate communication between providers and stakeholders to ensure seamless care delivery.
Proactively identify referral opportunities and promote integration with additional products, services, or programs.
Contribute to the enhancement of healthcare quality and effectiveness through proactive initiatives.
Offer consultation and expertise to internal and external stakeholders involved in utilization and benefit management.
Qualifications:
Registered Nurse with a minimum of 3 years of experience, including at least 1 year in managed care.
Active and unrestricted RN licensure in the state of residence.
Clinical experience in acute or post-acute settings.
Availability to work Monday through Friday, 8 AM to 5 PM in the resident time zone, with occasional weekends and holidays as needed.
Preferred Qualifications:
3+ years of clinical experience.
Associate's Degree required; Bachelor of Science in Nursing (BSN) preferred.
Pay Range:
The salary range for this role is competitive and commensurate with experience, ranging from $63,200.80 to $136,600.00 annually. Actual compensation will be determined based on factors such as experience, education, and location.
Benefits:
In addition to competitive compensation, we offer a comprehensive benefits package designed to support the well-being of our employees. This includes:
Medical, dental, and vision benefits.
401(k) retirement savings plan with company match.
Employee Stock Purchase Plan.
Term life insurance and disability benefits.
Well-being programs and education assistance.
CVS store discount and partner discount programs.
Paid Time Off (PTO), vacation pay, and paid holidays.
We are committed to fostering a supportive and inclusive work environment where every team member can thrive and make a difference. Join us in our mission to provide exceptional care to our members and communities.
Employment Type: Full-Time
Salary: $ 63,200.00 136,600.00 Per Year
