Nurse Consultant
2 weeks ago
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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