At CVS Health, we are passionate about transforming health care and caring for people where, when, and how they choose. We are looking for a Utilization Management Nurse Consultant to utilize clinical experience in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for our members.
What You'll Do
- 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 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
- 3+ years of experience as a Registered Nurse.
- Must have an active, current, and unrestricted RN licensure in your state of residence.
- 1+ years of Med/Surg experience.
- 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).
- Must be willing and able to work Monday through Friday, 10:00am to 7:00pm EST with an occasional holiday rotation.
Nice to Have
- Prior Authorization or Utilization Management experience.
- Managed care experience.
- Experience using MedCompass.
- Ambulatory surgery experience.
Technical Stack
- Microsoft Office (Outlook, Teams, Excel)
- MedCompass
Benefits & Compensation
- Compensation: $26.01 - $62.32 per hour.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost wellness screenings, tobacco cessation, and weight management programs.
- No-cost confidential counseling and financial coaching.
- Paid time off.
- Flexible work schedules.
- Family leave.
- Dependent care resources.
- Colleague assistance programs.
- Tuition assistance.
- Retiree medical access.
Work Mode
This position operates in a local-country work mode.
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 federal, state and local laws.
