Nurse Consultant

4 weeks ago

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

CVS Health is seeking a skilled Nurse Consultant to join our team. As a key member of our Utilization Management department, 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 in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determination/recommendations along the continuum of care.
  • Communicate with providers and other parties to facilitate care and treatment.
  • Identify members for referral opportunities to integrate with other products, services, and programs.
  • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
  • Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements:

  • 3+ years of experience as a Registered Nurse.
  • 3+ years of clinical experience required.
  • Must have active current and unrestricted RN licensure in the state of residence.
  • Must possess 1+ year(s) of clinical experience in an acute or post-acute setting.
  • Candidates must be able to work Monday through Friday, 8:30am-5pm or 10:30am-7pm, in the time zone of the work being supported.

Preferred Qualifications:

  • Managed Care experience.

Education:

  • Associate's Degree required.
  • BSN preferred.

Pay Range:

The typical pay range for this role is $32.01 - $68.55. 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.

Benefits:

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Eligible employees may also participate in the Company's term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs.

Work Environment:

This is a full-time telework role. Utilization Management is a 24/7 operation, and work schedules may include weekends, holidays, and evening hours. Candidates must be able to work Monday through Friday, 8:30am-5pm or 10:30am-7pm, in the time zone of the work being supported.

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