Utilization Management Nurse Consultant

CVS Health • Atlanta, GA

394d • $54,101 - $116,771 • Remote

About The Position

The Utilization Management Nurse Consultant at CVS Health plays a crucial role in assessing and coordinating healthcare services for members. This position requires clinical expertise to evaluate options for appropriate healthcare benefits, ensuring quality and effective utilization of services. The role involves collaboration with providers and other stakeholders to facilitate care, while also identifying opportunities for integration with additional services and programs. The position operates within a 24/7 environment, necessitating flexibility in work hours, including weekends and holidays.

Requirements

• 3+ years of experience as a Registered Nurse.
• 1+ years of clinical experience in an acute or post-acute setting.
• Active, current, and unrestricted RN licensure in the state of residence.
• Ability to obtain CA nursing license within 6 months of hire.

Nice To Haves

• 3+ years of clinical experience preferred.
• Managed Care experience preferred.

Responsibilities

• Utilize clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members.
• Gather clinical information and apply clinical criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products and services.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization management.

Benefits

• 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