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Clinical Nurse Consultant
1 month ago
CVS Health is seeking a skilled Clinical Nurse Consultant to join our team. As a key member of our Utilization Management department, you will play a critical role in coordinating, documenting, and communicating all aspects of our utilization/benefit management program.
As a Clinical Nurse Consultant, you will utilize your clinical skills to apply critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for the appropriate utilization of services. You will consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
You will gather clinical information and apply the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care. You will utilize your clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent or emergent interventions (such as triage/crisis support).
You will coordinate/communicate with providers and other parties to facilitate optimal care/treatment. You will identify members who may benefit from care management programs and facilitate referral. You will identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
This role requires proficiency with computer skills, including navigating multiple systems and keyboarding. A minimum of 3+ years of clinical practice experience as a Registered Nurse, preferably in an acute setting, is required. Current active and unrestricted RN licensure in the state of residence is also required.
This is a 24/7 operation, and the work schedule may include weekends, holidays, and evening hours. A minimum of 2+ years of experience using personal computers, keyboard navigation, navigating multiple systems, and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.) is also required.
Preferred qualifications include managed care experience, utilization management experience, pediatrics experience, and residing in Pennsylvania. An Associate's degree is required, and a BSN is preferred.
This role is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.
The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits.
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.
