[Hiring] Utilization Management Nurse Consultant @CVS Health

Role Description

Are you an experienced RN looking to bring your clinical expertise to a fast-paced, collaborative Utilization Management team? Join us in helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.

• Review clinical information and apply evidence-based criteria to support coverage determinations
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
• Collaborate with providers and care teams to facilitate appropriate treatment plans
• Identify opportunities to improve quality, efficiency, and healthcare utilization
• Connect members to additional programs and services as appropriate
• Serve as a clinical resource for internal and external stakeholders

Qualifications

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care and/or critical care nursing experience
• Strong clinical assessment and decision-making skills
• Ability to navigate multiple computer systems and manage competing priorities
• Excellent verbal and written communication skills
• Associate Degree in Nursing required
• Willing to work weekends, holidays, and evening shifts

Requirements

• 2+ years of Med-Surg or specialty nursing experience (preferred)
• Managed Care experience, particularly Utilization Management (preferred)
• Reside in the Eastern Time Zone (preferred)
• BSN preferred

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility