Nurse Consultant for Utilization Management
2 weeks ago
At CVS Health, we are dedicated to enhancing health care experiences by putting our heart into every interaction. Our mission is to provide personalized, accessible, and affordable health care solutions in a rapidly evolving environment.
Role Summary
This position is fully remote, with a requirement to reside in Florida. As a part of our 24/7 Utilization Management team, you will be expected to work various shifts, including weekends and holidays.
Key Responsibilities
- Utilize critical thinking and evidence-based clinical criteria to assess services requiring precertification.
- Spend the majority of your time reviewing clinical information from healthcare providers via phone and desk work.
- Authorize procedures and services based on established criteria or refer to a Medical Director when necessary.
Required Qualifications
- Active, unrestricted RN licensure in Florida.
- Residency in Florida is mandatory.
- Minimum of 3 years of clinical experience.
- Familiarity with personal computers and proficiency in MS Office Suite (Teams, Outlook, Word, Excel, etc.) for at least 2 years.
Preferred Qualifications
- Experience in prior authorization processes.
- Previous employment with a health plan is advantageous.
Educational Requirements
- An Associate's degree is required; a BSN is preferred.
Compensation and Benefits
The typical pay range for this role is $56.14 per hour. This range reflects the base hourly rate or base annual full-time salary for all positions within this job grade. Actual salary offers will depend on various factors such as experience, education, and geography. Additionally, this position is eligible for bonuses, commissions, or short-term incentive programs.
CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Eligible employees can also access fully-paid life insurance, short-term and long-term disability benefits, and various well-being programs. Paid Time Off (PTO), vacation pay, and paid holidays are provided in accordance with state law and company policies.
For further details on available benefits, please refer to our company resources. We are committed to equal opportunity and affirmative action in our hiring practices.
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