Utilization Management

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.

Position Summary

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours.

Weekend position - this position will be working two 10-hour shifts on the weekend and two 10-hour shifts on weekdays

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• There are standard productivity and quality expectations.
• Work requires the ability to perform close inspection of handwritten and computer generated documents.
• Sedentary work involving periods of sitting, talking, listening.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.

Required Qualifications

• Must have the ability to work a Weekend position (Sat/Sun + 2 weekdays)
• Must have active, current and unrestricted RN licensure in state of Kentucky or multi-state compact RN licensure.
• 3+ years of clinical experience.
• Position requires proficiency with computer skills which includes navigating multiple systems.
• Ability to work in a fast-paced environment.

Preferred Qualifications

• Previous prior authorization experience.

Education

• Associates degree required.
• BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full-time

Pay Range

$26.01 - $56.14

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

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.