Utilization Management Nurse Consultant (Weekend)

CVS Health • Tallahassee, FL

396d • $54,101 - $116,771 • Remote

About The Position

The Utilization Management Nurse Consultant at CVS Health is a remote position responsible for coordinating and managing healthcare services for members. This role requires clinical expertise to ensure that members receive appropriate care in a timely manner while adhering to regulatory guidelines. The position involves working four 10-hour shifts, including weekends and holidays, and requires effective communication and collaboration with healthcare providers and internal teams.

Requirements

• 3+ years of experience as a Registered Nurse
• Active and unrestricted RN licensure in the state of residence
• 1+ years of clinical experience in an acute or post-acute setting
• Willingness to work four 10-hour days including weekends and holidays
• Proficiency in computer skills, including navigating multiple systems and keyboarding
• Effective verbal and written communication skills.

Nice To Haves

• Strong technology skills with Microsoft Excel
• Managed care experience preferred
• Bachelor of Science in Nursing (BSN) preferred.

Responsibilities

• Utilize clinical skills to coordinate, document, and communicate aspects of the utilization/benefit management program.
• Ensure members receive appropriate care at the right time and location, adhering to federal and state regulations.
• Review written clinical records and apply clinical criteria to render coverage determinations.
• Communicate with providers to facilitate care and treatment for members.
• Identify members for referral opportunities to integrate with other services and programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents regarding utilization management.

Benefits

• Store discount
• Employee stock purchase plan
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Paid time off
• Vision insurance
• Life insurance

What This Job Offers

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