CVS Health logo
CVS Health

Bringing our heart to every moment of your health.

Utilization Management Nurse Consultant – Weekend

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

Location

Idaho + 2 moreAll locations: Idaho, Pennsylvania, Texas

Posted

1 day ago

Salary

$29 - $62 / hour

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

• 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 • 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

Job Requirements

  • Registered Nurse
  • 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
  • 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
  • Utilization review experience preferred
  • Experience with LTAC, skilled rehab, or home health preferred
  • Managed Care experience preferred
  • BSN preferred

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues 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
  • Many other benefits depending on eligibility

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Utilization Management Nurse Consultant

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Bringing our heart to every moment of your health.

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The role involves utilizing clinical experience in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members. This includes gathering clinical information, applying appropriate criteria/guidelines, rendering coverage determinations, and communicating with providers to facilitate care and treatment.

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$29 - $62 / hour