Utilization Management Nurse Consultant

Position Summary

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Schedules: 3-11 or 11-8
Location: Remote (Central Time)

About the role

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.

Responsibilities

• 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

Requirements

• Sedentary work involving periods of sitting, talking, listening
• Sitting for extended periods, talking on the telephone and typing on the computer
• Able to multitask, prioritize and effectively adapt to a fast paced changing environment

Preferred Qualifications

• 2+ years of clinical experience required in med surg or specialty area
• Managed Care experience preferred, especially Utilization Management
• Preference for those residing in Central Time zones

Qualifications

• 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

Skills

• Proficiency with computer skills which includes navigating multiple systems and keyboarding
• Effective communication skills, both verbal and written

Benefits

The typical pay range for this role is $26.01 - $56.14. 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. Great Benefits For Great People 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 well-being 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.