Nurse Consultant

2 weeks ago


Jefferson City, Missouri, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.

Key Responsibilities
  • Utilize clinical expertise to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Review written clinical records and apply clinical criteria, guidelines, policies, and procedures to render coverage determinations and recommendations.
  • Communicate with providers and other stakeholders to facilitate care and treatment, and identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
  • Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements
  • 3+ years of experience as a Registered Nurse.
  • Active, current, and unrestricted RN licensure in the state of residence.
  • 1+ years of clinical experience in an acute or post-acute setting.
Preferred Qualifications
  • Strong technology skills, including proficiency in Excel.
  • Managed care experience.
What We Offer

CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, 401(k) retirement savings plan, and employee stock purchase plan. We also offer a range of well-being programs, education assistance, and free development courses.

As a CVS Health employee, you will have the opportunity to work in a dynamic and supportive environment, with a focus on delivering exceptional patient care and improving health outcomes.



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