Nurse Consultant

2 weeks ago


Harrisburg, Pennsylvania, United States CVS Health Full time

About CVS Health

We put our heart into caring for our colleagues and communities, creating an environment where nurses can thrive. As a Utilization Management (UM) Nurse Consultant at CVS Health, you will leverage your clinical expertise to coordinate and communicate all aspects of the utilization/benefit management program.

Job Summary

This role is responsible for ensuring members receive the appropriate care at the right time and location while adhering to federal and state regulated turn-around times. You will review written clinical records to assure medical necessity and apply clinical expertise to ensure proper benefit utilization.

Key Responsibilities

  • Coordinate, document, and communicate all aspects of the utilization/benefit management program.
  • Apply clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
  • Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.
  • Communicate with providers and other parties to facilitate care/treatment.
  • Identify members for referral opportunities to integrate with other products, services, and/or programs.

Requirements

  • Active, current, and unrestricted RN licensure in the state of residence.
  • 3+ years of acute hospital clinical experience as an RN, preferably in medical-surgical and ICU settings.
  • 3+ years' experience with Microsoft Office Suite and ability to provide examples of navigating multiple computer systems and keyboarding at the same time.
  • Willingness and ability to work Monday through Friday, 8:30am to 5:00pm, in the time zone of residence.

Compensation

The estimated salary for this role is $55,000 - $115,000 per year, based on experience, education, and geography. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.



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