Nurse Consultant for Utilization Management

2 weeks ago


Jefferson City, Missouri, United States CVS Health Full time

About CVS Health: At CVS Health, we are united by a common mission: to enhance the health and well-being of our communities. Our commitment to delivering compassionate, human-centered healthcare is at the heart of everything we do.

Position Overview: This position is available for remote work across the United States.

Work Schedule: The work schedule consists of four 10-hour shifts, specifically on Saturday, Sunday, Wednesday, and one additional weekday to be determined. The hours for this role are from 8:00 AM to 6:30 PM in your respective time zone.

Training: The initial training period will last for six weeks, occurring Monday through Friday from 8:00 AM to 4:30 PM EST.

Holiday Rotation: Team members are required to participate in a holiday rotation, which includes working one major and one minor holiday each year.

Key Responsibilities:

  • Leverage clinical expertise to engage in a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates healthcare service options for members.
  • Collect clinical data and apply relevant clinical criteria, guidelines, policies, and clinical judgment to make informed coverage determinations throughout the care continuum.
  • Facilitate communication with healthcare providers and other stakeholders to ensure effective care and treatment.
  • Identify members who may benefit from referrals to integrate with additional products, services, or programs.
  • Seek opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.
  • Provide consultation and expertise to both internal and external stakeholders regarding the utilization and benefit management processes.
  • Maintain productivity and quality standards in a typical office environment.
  • Perform detailed inspections of handwritten and digital documents, requiring prolonged periods of sitting, active listening, and computer use.
  • Demonstrate strong multitasking abilities and adapt effectively to a fast-paced work environment.
  • Exhibit proficiency in computer skills, including navigating multiple systems and keyboarding.
  • Communicate effectively, both verbally and in writing.

Required Qualifications:

  • A minimum of 3 years of experience as a Registered Nurse.
  • Active and unrestricted RN licensure in the state of residence.
  • At least 1 year of clinical experience in an acute or post-acute care setting.

Preferred Qualifications:

  • Proficient technology skills, particularly in Excel.
  • Experience in Managed Care is preferred.

Education:

  • Associate's Degree or Nursing Diploma is required.
  • Bachelor of Science in Nursing (BSN) is preferred.

Compensation:

The typical pay range for this role is $56.14 per hour. This range reflects the base hourly rate or annual salary for all positions within the job grade. Actual salary offers will vary based on experience, education, geography, and other relevant factors.

Benefits: CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, an Employee Stock Purchase Plan, fully-paid term life insurance, and both short-term and long-term disability benefits. Employees also have access to various well-being programs, educational assistance, and discounts.

Diversity and Inclusion: CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruitment, 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 law.


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