Utilization Management Nurse Consultant

CVS Health

1d • $29 - $62 • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: This Utilization Management Nurse Consultant (UMNC) position is a work at home position (fully remote) and the candidate can live in any state. Normal Working Hours: Monday through Friday 8:00am-6:00pm in the time zone of residence. In addition, the team is open to candidates in PST and/or MST time zones to provide increased daily coverage until 6:30pm EST (10:00am-6:30pm EST). There is a weekend rotation per the needs of the department. Minimal travel is expected but could be up to 10% in the event of a clinical audit. As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Looking for someone who is high energy and motivated team environment and is detail oriented and highly organized. The UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.

Requirements

• Must have an active and unrestricted RN license
• 2+ years of recent acute hospital clinical experience as an RN (recent defined as in the past 10 years).

Nice To Haves

• Utilization Review experience
• Managed Care background
• Strong telephonic communication skills
• BSN
• Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

Responsibilities

• Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times.
• Reviewing written clinical records.
• Reviews services to assure medical necessity
• Applies clinical expertise to assure appropriate benefit utilization
• Facilitates safe and efficient discharge planning
• Works closely with facilities and providers to meet the complex needs of the member.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree