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Clinical Utilization Management Nurse Specialist
2 months ago
About CVS Health
At CVS Health, we are united by a common goal: to bring compassion to every aspect of health care. Our mission is to enhance human-centric health care in a rapidly evolving environment.
Position Overview
This role is fully remote, with a requirement to reside in Florida. The Utilization Management department operates around the clock, which may necessitate working on weekends, holidays, and evenings.
Key Responsibilities
- Utilize critical thinking and evidence-based clinical criteria to assess services requiring precertification.
- Spend the majority of your time at a desk and on the phone, gathering and evaluating clinical information from healthcare providers.
- Employ specific criteria to authorize procedures and services or refer to a Medical Director when necessary.
Qualifications
Required:
- Active, current, and unrestricted RN licensure in Florida.
- Residency in Florida.
- Minimum of 3 years of clinical experience.
- Experience in a 24/7 operational environment, with potential for weekend, holiday, and evening shifts.
- At least 2 years of proficiency in using personal computers, navigating multiple systems, and utilizing MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).
Preferred:
- Prior authorization experience.
- Previous employment with a health plan.
Education
- Associate's degree required; BSN preferred.
Compensation
The typical pay range for this position is $56.14 per hour. This range reflects the base hourly rate or annual salary for all roles within this job grade. Actual salary offers will depend on various factors, including experience, education, and geographic location.
Benefits
CVS Health offers a comprehensive benefits package, including:
- Medical, dental, and vision coverage.
- 401(k) retirement savings plan and Employee Stock Purchase Plan.
- Fully-paid term life insurance and short-term/long-term disability benefits.
- Paid Time Off (PTO), vacation pay, and paid holidays.
- Access to well-being programs, education assistance, and professional development courses.
Diversity and Inclusion
CVS Health is an equal opportunity and affirmative action employer. We are committed to fostering a diverse workforce and do not discriminate 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 law.
