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.