Utilization Management Nurse Consultant

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. Schedule:   This is an Alternative Work   Schedule   weekend position. The role requires coverage of both Saturday and Sunday each week.   Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs.   Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.

Summary:   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.     Key Responsibilities:     * 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.     Required Skills and Abilities:     * Effective verbal and written communication skills.   *   Proficiency   with computer skills, including navigating multiple systems and keyboarding.   * Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.   * Capacity to sit for extended periods, talk on the telephone, and type on the computer.     Work Location:     This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the   office or client location may be   required   for meetings, training sessions, or other events as directed.     ` Required Qualifications   Registered Nurse    Education:   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 ,   and    1 + years of Utilization Management / Care   Manage ment   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.     *   Preferred Qualifications   -   Utilization   Management experience preferred       Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  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