Nurse Consultant for Utilization Management

2 weeks ago


Jefferson City, Missouri, United States CVS Health Full time
Position Overview

At CVS Health, we are committed to delivering compassionate health care solutions. Our mission revolves around enhancing human-centric health care in a rapidly evolving landscape.

Key Responsibilities
  • Employ clinical expertise to collaboratively assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members.
  • Collect clinical data and apply relevant clinical criteria, guidelines, and policies to make informed coverage determinations throughout the care continuum.
  • Engage with healthcare providers and stakeholders to facilitate effective treatment and care.
  • Identify members for referral opportunities to integrate with additional services and programs.
  • Recognize opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.
  • Provide consultation and expertise to internal and external partners in managing utilization and benefits.
  • Work in a typical office environment with established productivity and quality standards.
  • Perform detailed inspections of documents and utilize computer systems effectively.
  • Engage in sedentary work that includes extended periods of sitting, communication via phone, and computer usage.
  • Demonstrate the ability to multitask, prioritize, and adapt to a dynamic work environment.
  • Exhibit proficiency in computer skills, including navigating multiple systems and typing.
  • Possess strong verbal and written communication skills.
Required Qualifications
  • Minimum of 3 years of experience as a Registered Nurse.
  • Active and unrestricted RN licensure in the state of residence.
  • At least 1 year of clinical experience in acute or post-acute settings.
  • Flexibility to work in a 24/7 operation, including weekends, holidays, and evening shifts.
  • Availability to work Monday through Friday from 8:30 AM to 5 PM CST.
Preferred Qualifications
  • Experience in managed care.
  • Background in discharge planning.
  • Familiarity with utilization management.
Education
  • Associate's Degree or Nursing Diploma required.
  • Bachelor of Science in Nursing (BSN) preferred.
Compensation and Benefits
The typical pay range for this role is $56.14 per hour. This range represents the base hourly rate for all positions within this job grade. Actual salary offers will vary based on factors such as experience, education, and geography. This position is eligible for a bonus, commission, or short-term incentive program in addition to the base pay range. CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Additional benefits include fully-paid life insurance, short-term and long-term disability benefits, well-being programs, education assistance, and employee discounts. Paid Time Off (PTO) and paid holidays are also provided, in accordance with state laws and company policies.
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