Nurse Consultant for Utilization Management

2 weeks ago


Harrisburg, Pennsylvania, United States CVS Health Full time
Position Overview:
As a pivotal member of CVS Health, the Utilization Management Nurse Consultant plays a crucial role in enhancing patient care through effective utilization management strategies. This position is fully remote, allowing for flexibility while maintaining a focus on delivering quality healthcare.

Key Responsibilities:
  • Utilize clinical expertise to assess and ensure the medical necessity of services provided to members.
  • Coordinate and document all facets of the utilization management program, ensuring compliance with federal and state regulations.
  • Engage in collaborative processes to evaluate and implement healthcare options that meet the diverse needs of members.
  • Communicate effectively with healthcare providers and stakeholders to facilitate optimal care and treatment pathways.
  • Identify opportunities for quality improvement in healthcare services and benefit utilization.
  • Provide consultation and support to internal and external parties regarding utilization management processes.

Qualifications:
Required:
  • Active and unrestricted RN licensure in Pennsylvania.
  • A minimum of three years of clinical experience in an acute care setting, preferably in medical-surgical or ICU.
  • Proficiency in Microsoft Office Suite and experience navigating multiple computer systems.
  • Availability to work standard hours with occasional evening and weekend shifts as needed.

Preferred:
  • Experience in Utilization Review and Managed Care.
  • Strong telephonic communication skills and organizational abilities.
  • Associate Degree required; BSN preferred.

Compensation and Benefits:
The compensation for this role is competitive and reflects the experience and qualifications of the candidate. CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and various well-being programs. Employees also enjoy paid time off and holiday benefits, ensuring a healthy work-life balance.

CVS Health is committed to fostering an inclusive workplace and is an equal opportunity employer.

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