Utilization Management Nurse Consultant

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. 
   
  Key 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. 
   
  Required Skills and Abilities: 
   
  * 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. 
   
  Work Location: 
   
  This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed. 

 
`Required Qualifications 

• 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, and  1+ years of Utilization Management / Care Management Experience  

• Must have active current and unrestricted RN licensure in state of residence.  

• May