CVS Health is looking for a Utilization Management Nurse Consultant to leverage clinical experience in a collaborative process assessing, planning, and evaluating healthcare services. This is an Alternative Work Schedule weekend position requiring coverage of both Saturday and Sunday each week. You will play a key role in facilitating appropriate care and benefits for members.
What You'll Do
- Gather clinical information and apply appropriate clinical criteria, guidelines, and judgment to render coverage determinations.
- Communicate with providers and other parties to facilitate care and treatment.
- Identify members for referral opportunities to integrate with other products, services, or benefits.
- Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination of the utilization/benefit management function.
- Meet set productivity and quality expectations as established by UMNC.
What We're Looking For
- Registered Nurse (Diploma RN acceptable; Associate degree/BSN preferred).
- 3+ years of experience as a Registered Nurse.
- 1+ years of clinical experience in an acute or post-acute setting.
- 1+ years of Utilization Management or Care Management experience.
- Active, current, and unrestricted RN licensure in state of residence.
- May be required to obtain additional Nursing Licenses as business needs require.
- Effective verbal and written communication skills.
- Proficiency with computer skills, including navigating multiple systems and keyboarding.
- Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
- Capacity to sit for extended periods, talk on the telephone, and type on the computer.
Nice to Have
- Utilization Management experience preferred.
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, 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 is a hybrid, remote position.
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.
