Utilization Management Nurse Consultant, CVS Health

Utilization Management Nurse Consultant

CVS Health

Location:

United States, New Jersey

Category:

Nursing

Contract Type:

Not provided

Salary:

34.92 - 74.78 USD / Hour

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Job Description:

Clinical role focusing on assessing, planning, implementing and coordinating healthcare services/benefits for members within Utilization Management function at CVS Health. Responsibilities involve collaborative care, communicating with providers, promoting quality effectiveness, and proficiency with computer skills.

Job Responsibility:

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
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:

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

Nice to have:

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

What we offer:

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

Additional Information:

Job Posted:

March 20, 2025

Expiration:

April 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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