Utilization Management Nurse Consultant

CVS Health

2d • $29 - $62 • Remote

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. Schedule: This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage. Position Summary Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.

Requirements

• Effective verbal and written communication skills.
• Proficiency with computer skills, including navigating multiple systems and keyboarding.
• Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
• Capacity to sit for extended periods, talk on the telephone, and type on the computer.
• Registered Nurse
• Education: Diploma RN acceptable; Associate degree/BSN preferred
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting
• 1+ years of Utilization Management / Care Management Experience
• Must have active current and unrestricted RN licensure in state of residence.
• May be required to obtain additional Nursing Licenses as business needs require.

Nice To Haves

• Utilization review experience
• Experience with LTAC, skilled rehab, or home health
• Managed Care experience

Responsibilities

• Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products, services, or benefit programs.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Meet set productivity and quality expectations as established by UMNC.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree