Utilization Management Nurse Consultant

5 days ago

Albany, New York, United States CVS Health Full time
Job Summary

CVS Health is seeking a highly skilled Utilization Management Nurse Consultant to join our team. As a Utilization Management Nurse Consultant, you will play a critical 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 assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Gather clinical information and apply relevant clinical criteria, guidelines, policies, procedures, and judgment to render coverage determinations and recommendations.
  • Communicate with providers and other parties to facilitate care and treatment, identify members for referral opportunities, and 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.
  • 1+ years of clinical experience in an acute or post-acute setting.
  • Active, current, and unrestricted RN licensure in the state of residence.
  • Ability to work Monday through Friday, 8:30am to 5pm or 10:30am to 7pm in the Central Time Zone.
Preferred Qualifications
  • Managed Care experience.
  • 1+ year(s) of Med/Surg experience.
Education

Associates Degree.

BSN preferred.

Pay Range

The typical pay range for this role is $68.55 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.

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan.

Eligible employees may also participate in the Company's paid time off program, which includes paid holidays, sick time, and vacation pay.

For more detailed information on available benefits, please visit the CVS Health website.

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