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Nurse Consultant for Utilization Management

2 months ago

Chandler, Arizona, United States CVS Health Full time
About CVS Health

At CVS Health, we are dedicated to enhancing health care experiences through our heartfelt commitment to our members. Our mission is to provide personalized, accessible, and affordable health care solutions in a rapidly evolving landscape.

Position Overview
We are seeking a skilled Utilization Management Nurse Consultant who will primarily work remotely after an initial training period. This role requires residing within a specific distance from the office location. The position involves:
  • Conducting telephonic assessments and case management activities to evaluate members' medical needs.
  • Implementing strategies to ensure optimal wellness and facilitate transitions to Aetna programs.

Key Responsibilities
As a Precertification Nurse, you will:
  • Utilize clinical judgment to identify and address health risks and barriers impacting care.
  • Perform comprehensive assessments considering co-morbid conditions and their effects on functionality.
  • Review historical claims to inform current case management decisions.
  • Collaborate with multidisciplinary teams to enhance overall claim management.
  • Adhere to regulatory and company policies throughout the case management process.

Qualifications
  • Active and unrestricted RN state licensure in Arizona.
  • A minimum of three years of clinical nursing experience.
  • Proficiency in Microsoft Office Suite.

Preferred Skills
Ability to prioritize tasks and work efficiently in a dynamic environment.

Education
Associate's degree required; BSN preferred.

Compensation and Benefits
The compensation for this role is competitive and includes a comprehensive benefits package, such as:
  • Medical, dental, and vision coverage.
  • 401(k) retirement savings plan.
  • Paid Time Off and holiday pay.

At CVS Health, we value diversity and are committed to creating an inclusive environment for all employees. We are an equal opportunity employer, and we do not discriminate based on any protected characteristic.