Utilization Management Nurse Consultant

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 passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Schedule: 
This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage. 
 
Position Summary: 
Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members. 
 
Key Responsibilities: 
 
* Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care. 
* Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs. 
* Identify opportunities to promote quality and 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. 
* Meet set productivity and quality expectations as established by UMNC. 
 
Required Skills and Abilities: 
 
* Effective verbal and written communication skills. 
* Proficiency with computer skills, including navigating multiple systems and keyboarding. 
* Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. 
* Capacity to sit for extended periods, talk on the telephone, and type on the computer. 
 
Work Location: 
 
This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed. 

 
`Required Qualifications

• Registered Nurse 

• Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and  1+ years of Utilization Management / Care Management Experience 

• Must have active current and unrestricted RN licensure in state of residence. 

• May be required to obtain additional Nursing Licenses as business needs require.

 
* Preferred Qualifications 
- Utilization Management experience preferred 

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.