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Nurse Consultant for Utilization Management
2 months ago
About CVS Health
At CVS Health, we are dedicated to a singular mission: to enhance every moment of your health journey. Our commitment is to provide human-centric healthcare solutions in a rapidly evolving landscape. We believe that the manner in which we deliver our services is as crucial as the services themselves. Our Heart At Work Behaviors embody this philosophy, empowering every employee to contribute to a transformative culture and to innovate in ways that make healthcare more personal, accessible, and affordable.
Position Overview
The role of the Utilization Management Nurse Consultant is fully remote, allowing candidates from any state to apply. This position does not require travel.
Key Responsibilities
- Utilize clinical expertise to coordinate, document, and communicate all facets of the utilization and benefit management program.
- Ensure members receive appropriate care in a timely manner and at suitable locations, adhering to regulatory turnaround times.
- Review clinical records to confirm medical necessity and facilitate efficient discharge planning.
- Engage collaboratively with healthcare facilities and providers to address the complex needs of members.
- Assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members.
- Gather clinical information and apply relevant criteria and guidelines to make informed coverage determinations.
- Communicate effectively with providers and other stakeholders to facilitate care and treatment.
- Identify members for referral opportunities to integrate with additional services and programs.
- Promote quality and effectiveness in healthcare services and benefit utilization.
- Provide expertise to internal and external partners in the administration of utilization and benefit management functions.
Required Qualifications
- Active, unrestricted RN licensure in the state of residence.
- A minimum of 3 years of acute hospital clinical experience as an RN, with a preference for medical-surgical and ICU backgrounds.
- Availability to work Monday through Thursday from 8:00 AM to 4:30 PM and Friday from 8:30 AM to 5:00 PM, with occasional weekend and holiday hours.
Preferred Qualifications
- 1+ years of experience in Utilization Review.
- 1+ years of experience in Managed Care.
- Strong telephonic communication skills.
- 1+ years of proficiency with Microsoft Office Suite.
- Preference for candidates located in the Arizona Time Zone.
Education
- Associate's Degree required; BSN preferred.
Compensation and Benefits
The typical pay range for this role is: $56.14. This range reflects the base hourly rate or annual salary for all positions within this job grade. Actual offers may vary based on experience, education, geography, and other relevant factors. In addition to competitive compensation, 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 also receive fully-paid term life insurance, short-term and long-term disability benefits, and various well-being programs. Paid Time Off (PTO) and paid holidays are also provided in accordance with state law and company policies.
Diversity and Inclusion
CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruitment, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable law.
