CVS Health

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Utilization Management Nurse Consultant

ConsultantConsultantFull TimeRemoteTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Kansas

Posted

2 days ago

Salary

$26 - $56 / hour

Associate Degree2 yrs expEnglish

Job Description

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members • Gather clinical information and apply appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation • Communicate with providers and other parties to facilitate care/treatment • Identify members for referral opportunities to integrate with other products, services and/or 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 • Typical office working environment with productivity and quality expectations • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

Job Requirements

  • 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
  • Must have active current and unrestricted RN licensure in state of residence
  • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
  • 2+ years of clinical experience required in med surg or specialty area preferred
  • Managed Care experience preferred, especially Utilization Management
  • Associates Degree required, BSN preferred

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs including wellness screenings, tobacco cessation and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

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