Description
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.
Job Summary: As a Utilization Management Nurse Consultant, you will utilize 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.
Responsibilities:
- Gather clinical information and apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations 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 programs.
- Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements:
- 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting.
- Active current and unrestricted RN licensure in the state of residence.
- Must reside in EST or CST.
- Utilization Management is a 24/7 operation, and work schedules will include weekends, holidays, and evening hours.
Technical and Logistical Requirements:
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
- Communication Tools: Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- Systems Access & Security: Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently.
Work from Home Requirements:
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer.
- Quiet, secure, and private designated home virtual work location.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
Preferred Qualifications:
- 2+ years of clinical experience in med surg or specialty area.
- Managed Care experience preferred, especially Utilization Management.
Education:
- Associate's Degree required.
- BSN preferred.
Anticipated Weekly Hours: 40
Pay Range: $29.10 - $62.32