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Clinical Utilization Management Consultant

4 weeks ago

Renton, Washington, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Utilization Management (UM) Nurse Consultant to join our team. As a key member of our healthcare services team, you will play a critical role in assessing, planning, implementing, coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services and benefits for our members.

Key Responsibilities
  • Utilize clinical experience and skills to assess and plan healthcare services and benefits for members.
  • Apply clinical criteria, guidelines, policies, and procedures to render coverage determinations and recommendations.
  • Communicate with providers and other parties to facilitate care and treatment.
  • Identify opportunities to promote quality 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 and unrestricted RN licensure in the state of residence.
  • 1+ year of Med/Surg experience.
  • 1+ year of inpatient utilization experience.
  • 1+ year of experience with Microsoft Office applications (Outlook, Teams, Excel).
  • Ability to work a Monday-Friday schedule from 8:00 am - 4:30 pm Eastern Standard Time.
  • Ability to work weekends (1 to 2 per month) and holiday rotation (1 to 2 per year).
Preferred Qualifications
  • Experience working with Medicare/Medicaid populations.
  • MCG experience.
  • Managed care experience.
  • UM Certification.
  • MedCompass experience.
Education

Associates degree required. BSN preferred.

Compensation

The typical pay range for this role is $62.31 per hour. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.