Utilization Management Nurse Consultant

CVS Health

1d•Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.

Requirements

Must have active, current and unrestricted RN licensure in state of Virginia or multi state compact licensure
3+ years of clinical experience
Proficiency with computer skills which includes navigating multiple systems
Ability to work in a fast paced environment

Nice To Haves

Previous prior authorization experience

Responsibilities

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification.
Collects and reviews clinical information from providers.
Uses specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.