CVS Health is hiring a Utilization Management Nurse Consultant to play a pivotal role in transforming health care. At CVS Health, we are building a world of health around every consumer in a way that is more connected, convenient, and compassionate. In this role, you will apply your clinical expertise to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for our members.
What You'll Do
- Utilize clinical experience to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits.
- Gather clinical information and apply clinical criteria, guidelines, and judgment to render coverage determinations and recommendations.
- Communicate with providers and other parties to facilitate care and treatment plans.
- Identify members for referral opportunities to integrate with other products, services, and programs.
- Identify opportunities to promote the quality and effectiveness of healthcare services and benefit utilization.
- Consult with internal and external constituents on the coordination and administration of utilization and benefit management.
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 scheduled shifts that include weekends, holidays, and evening hours, as Utilization Management is 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.
- Residence in an Eastern Standard Time (EST) zone.
- A Bachelor of Science in Nursing (BSN) degree.
Benefits & Compensation
- Compensation range: $32.01 - $68.55 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 and flexible work schedules.
- Family leave and dependent care resources.
- Colleague assistance programs.
- Tuition assistance and retiree medical access.
Work Mode
This position is an onsite role.
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.
