Quality Management Nurse Consultant
6 days ago
We are seeking a skilled Nurse Consultant to join our team at CVS Health. As a Utilization Management Nurse, you will play a critical role in coordinating, documenting, and communicating all aspects of the utilization/benefit management program.
Key Responsibilities- Utilize clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products, services, and/or programs.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
- Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
- Position requires proficiency with computer skills, including navigating multiple systems and keyboarding.
- Utilization management is a 24/7 operation. Work schedules will include a minimum of 6 weekend rotations per year, as well as holidays and evening rotations.
- A competitive salary and bonus structure.
- A comprehensive benefits package, including medical, dental, and vision coverage.
- A 401(k) retirement savings plan and an Employee Stock Purchase Plan.
- A fully-paid term life insurance plan and short-term and long-term disability benefits.
- Well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
- Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
We are an equal opportunity employer and welcome applications from diverse candidates. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
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