Clinical Nurse Consultant

3 weeks ago


Indianapolis, Indiana, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Clinical Nurse Consultant to join our team. As a key member of our Utilization Management department, you will play a critical role in assessing, planning, implementing, coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services and benefits for our members.

Key Responsibilities

- Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
- Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determination and recommendations 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 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 the utilization/benefit management function.

Requirements

- 3+ years of experience as a Registered Nurse.
- Must have active current and unrestricted RN licensure in the state of residence.
- 1+ year(s) of Med/Surg experience.
- 1+ year(s) of experience with Microsoft Office applications (Outlook, Teams, Excel).

Preferred Qualifications

- Prior Authorization or Utilization Management experience.
- Managed care experience.
- Experience using MedCompass.
- Ambulatory surgery experience.

What We Offer

- Competitive pay range: $26.01 - $56.14.
- Eligibility for a CVS Health bonus, commission, or short-term incentive program.
- Comprehensive benefits package, including medical, dental, and vision benefits.
- 401(k) retirement savings plan and Employee Stock Purchase Plan.
- Fully-paid term life insurance plan and short-term and long-term disability benefits.
- Well-being programs, education assistance, and free development courses.
- CVS store discount and discount programs with participating partners.
- Paid Time Off (PTO) or vacation pay and paid holidays throughout the calendar year.

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