CVS Health is hiring a Utilization Management Nurse Consultant to leverage clinical expertise in a collaborative process that assesses, plans, and coordinates appropriate healthcare services for members. You will gather clinical information and apply clinical criteria, guidelines, and your own judgment to render coverage determinations. We are building a world of health around every consumer, surrounded by colleagues passionate about transforming health care in a more connected, convenient, and compassionate way.
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 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 utilization and benefit management.
What We're Looking For
- 3+ years of experience as a Registered Nurse.
- 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).
- Willingness and ability to work Monday through Friday, 9:00am to 5:30pm eastern or central time with occasional holiday rotation.
- An Associate's degree is required.
Nice to Have
- Prior Authorization or Utilization Management experience.
- Managed care experience.
- Experience using MedCompass.
- Ambulatory surgery experience.
- A BSN is preferred.
Technical Stack
- Microsoft Office (Outlook, Teams, Excel)
- MedCompass
Benefits & Compensation
- Compensation: $29.10 - $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, and family leave.
- Dependent care resources and colleague assistance programs.
- Tuition assistance and 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.
