Utilization Management Nurse Consultant

2 days ago


Sacramento, California, 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 healthcare team, you will play a vital 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 coordinate and document all aspects of the utilization/benefit management program.
  • Ensure that members receive the most appropriate care at the right time and in the right setting, while adhering to federal and state regulated turn-around times.
  • Collaborate with providers and other stakeholders to facilitate care and treatment.
  • 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.
  • Ability to work a 24/7 operation, including weekends and holidays, and evening rotations.
Preferred Qualifications
  • 3+ years of clinical experience.
  • Managed Care experience.
What We Offer

CVS Health offers a competitive salary range of $32.01 - $68.55, as well as a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also offer a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs.



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