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Clinical Utilization Management Nurse Specialist
2 months ago
At CVS Health, we are dedicated to enhancing health care through a compassionate approach. Our mission is to deliver personalized health solutions that cater to the evolving needs of our communities.
Position Overview
This role is fully remote, with a requirement to reside in Florida. As a Utilization Management Nurse Consultant, you will be part of a 24/7 operational team, and your work schedule may include weekends, holidays, and evening shifts.
Key Responsibilities
- Utilize critical thinking and evidence-based clinical criteria to assess services requiring precertification.
- Spend the majority of your time at a desk and on the phone, gathering and reviewing clinical information from healthcare providers.
- Authorize procedures and services based on specific criteria or refer to a Medical Director when necessary.
Required Qualifications
- Active, current, and unrestricted RN licensure in Florida.
- Must reside in Florida.
- A minimum of 3 years of clinical experience.
- At least 2 years of experience with personal computers, navigating multiple systems, and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).
Preferred Qualifications
- Experience in prior authorization processes.
- Previous work experience with a health plan.
Education Requirements
- An Associate's degree is required; a BSN is preferred.
Compensation
The typical pay range for this role is $56.14 per hour. This 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 various factors, including experience, education, and other relevant criteria.
Benefits
CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage. Eligible employees may enroll in the Company's 401(k) retirement savings plan and participate in an Employee Stock Purchase Plan. Additional benefits include fully-paid term life insurance, short-term and long-term disability coverage, well-being programs, education assistance, and discounts with participating partners. Employees also enjoy Paid Time Off (PTO) and paid holidays throughout the year.
Equal Opportunity Employer
CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, 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 federal, state, or local law.
