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. Registered Nurse (RN) – Utilization Management (24/7 Operations) Leverage your clinical expertise to make a broader impact. Join our Utilization Management team and help ensure members receive the right care at the right time across the healthcare continuum.
Requirements
- Active, unrestricted RN license in your state of residence
- 2+ years of adult acute care or critical care experience
- Strong clinical judgment and effective communication skills
- Ability to multitask and work efficiently in a fast-paced, technology-driven environment
Nice To Haves
- Experience in Med-Surg or a specialty area
- Managed Care or Utilization Management experience
- Located in the Eastern Time Zone
Responsibilities
- Review clinical documentation and apply criteria to support coverage determinations
- Collaborate with providers and care teams to coordinate appropriate care
- Identify opportunities to improve care quality and effective benefit utilization
- Connect members to programs and services that enhance outcomes
- Serve as a clinical resource to internal and external stakeholders
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
