CVS Health is looking for a Utilization Management Nurse Consultant who will apply clinical judgment to assess, plan, and coordinate healthcare services. This role is critical to our mission of building a world of health around every consumer, and it operates in a 24/7 environment requiring work on weekends, holidays, and evenings.
What You'll Do
- Utilize clinical experience in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits.
- Gather clinical information and apply appropriate clinical criteria, guidelines, policy, procedure, and clinical judgment to render coverage determinations 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, and/or programs.
- Identify opportunities to promote the quality 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 and benefit management function.
What We're Looking For
- 2+ years of experience as a Registered Nurse in an adult acute care or critical care setting.
- Active, current, and unrestricted RN licensure in your state of residence.
- Ability to work schedules that include weekends, holidays, and evening hours in a 24/7 operation.
Nice to Have
- 2+ years of clinical experience in med surg or a specialty area.
- Managed Care experience, especially in Utilization Management.
- Preference for candidates residing in Central Standard Time zones.
Benefits & Compensation
- Compensation range: $26.01 - $56.14 per hour.
- Affordable medical plan options.
- 401(k) plan with matching company contributions and an employee stock purchase plan.
- No-cost wellness screenings, tobacco cessation, weight management programs, confidential counseling, and financial coaching.
- Paid time off and flexible work schedules.
- Family leave and dependent care resources.
- Colleague assistance programs and tuition assistance.
- Retiree medical access.
Work Mode
This position is designated as onsite.
CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
