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Nurse Consultant for Utilization Management
2 months ago
About CVS Health: At CVS Health, we are dedicated to enhancing the health and well-being of our communities. Our mission is to provide personalized, accessible healthcare solutions that meet the evolving needs of our members.
Position Overview: This role is designed for a skilled nurse who will leverage their clinical expertise to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for our members. The position is fully remote, allowing you to work from anywhere in the United States.
Work Schedule: The typical schedule for this position consists of four 10-hour shifts, including weekends and one weekday, with hours from 8:00 AM to 6:30 PM in your local time zone. Initial training will occur Monday through Friday during standard business hours.
Key Responsibilities:
- Utilize clinical judgment and established guidelines to determine coverage decisions for healthcare services.
- Engage with healthcare providers and stakeholders to facilitate effective treatment plans.
- Identify opportunities for member referrals to enhance service integration.
- Promote quality and efficiency in healthcare service utilization.
- Provide expert consultation to internal and external partners regarding utilization management processes.
- Maintain productivity and quality standards in a typical office environment.
- Demonstrate proficiency in navigating multiple computer systems and performing detailed document reviews.
Qualifications:
Required:
- A minimum of 3 years of experience as a Registered Nurse.
- Active and unrestricted RN licensure in your state of residence.
- At least 1 year of clinical experience in an acute or post-acute care setting.
Preferred:
- Proficiency in technology, particularly with Excel.
- Experience in managed care environments.
Education:
- Associate's Degree or Nursing Diploma is required.
- Bachelor of Science in Nursing (BSN) is preferred.
Compensation and Benefits: The typical pay range for this role is $56.14 per hour. In addition to competitive pay, CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and various wellness programs. Employees also enjoy paid time off and holiday pay, in accordance with company policies.
Diversity and Inclusion: CVS Health is an equal opportunity employer and values diversity in the workplace. We are committed to creating an inclusive environment for all employees.
