Utilization Management Nurse Consultant - Remote

CVS Health • Albany, NY

414d • $54,101 - $142,584 • Remote

About The Position

The Utilization Management Nurse Consultant at CVS Health is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services for members. This remote position requires collaboration with providers and other parties to facilitate care and treatment, while also ensuring compliance with clinical guidelines and policies. The role involves working in a fast-paced environment with expectations for productivity and quality, and may require working evenings, weekends, and holidays.

Requirements

• 3+ years of acute experience as a Registered Nurse.
• Active current and unrestricted RN licensure in state of residence.
• 1+ year(s) of experience with MS Office suites.

Nice To Haves

• Managed Care experience
• Medicare experience

Responsibilities

• Utilizes clinical experience to assess and facilitate appropriate healthcare services for members.
• Gathers clinical information to render precertification coverage determinations.
• Communicates with providers and other parties to facilitate care and treatment.
• Identifies members for referral opportunities to integrate with other products and services.
• Promotes benefit utilization opportunities.

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs.
• Education assistance and free development courses.
• CVS store discount and discount programs with partners.
• Paid Time Off (PTO) and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Health and Personal Care Retailers
• Education Level: Associate degree