Utilization Management Nurse Consultant

2 days ago

Trenton, New Jersey, United States CVS Health Full time
Job Summary

CVS Health is seeking a highly skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the highest quality care while minimizing unnecessary costs.

Key Responsibilities
  • Utilize clinical expertise to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Gather clinical information and apply relevant clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations.
  • Communicate effectively with providers and other stakeholders to facilitate care and treatment.
  • Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
  • Consult and lend expertise to internal and external constituents in the coordination and administration of utilization and benefit management functions.
Requirements
  • Active, current, and unrestricted RN licensure in the state of residence.
  • Minimum of 3 years of experience as a Registered Nurse.
  • 1+ years of clinical experience in acute or post-acute settings.
  • 2+ years of experience working with MS Office applications, including Teams, Outlook, Excel, and Word.
  • Ability to work in a fast-paced environment while multitasking.
Preferred Qualifications
  • Experience working in ER, Med/Surg, and/or Critical Care settings.
  • Managed Care experience.
  • Utilization review experience.
  • Experience working with electronic medical record systems, such as EPIC, Cerner, or Meditech.
What We Offer

CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) retirement savings plan and employee stock purchase plan. We also provide a fully-paid term life insurance plan and short-term and long-term disability benefits. In addition, we offer numerous well-being programs, education assistance, and free development courses.

As a CVS Health employee, you will have access to a range of benefits and perks, including paid time off, paid holidays, and a CVS store discount. We are an equal opportunity and affirmative action employer, and we do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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