Utilization Management Nurse Consultant

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Utilization Management is a 24/7 operation and work schedule will include weekends, holidays and evening hours. Must reside in CST or EST zone.

As a Utilization Management Nurse Consultant you will utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

• Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs

• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

• Typical office working environment with productivity and quality expectations.

• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

• Sedentary work involving periods of sitting, talking, listening.

• Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

• Effective communication skills, both verbal and written

Required Qualifications

• 3+ years of experience as a Registered Nurse

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

• 1+ years of clinical experience in acute or post acute setting

• Requirement to reside in EST or CST zone.

• Utilization Management is a 24/7 operation and work schedule will include weekends, holidays and evening hours

 

Preferred Qualifications

• Managed Care experience preferred

Education

Associates Degree required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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