Utilization Management Nurse Consultant
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
- 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.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
