Experienced Full Stack Utilization Management Nurse Consultant – Clinical Expertise in Web-Based Healthcare Solutions
About Us
CVS Health is a dynamic and innovative healthcare company that is revolutionizing the way healthcare is delivered. With a clear purpose of bringing our heart to every moment of your health, we strive to deliver enhanced human-centric healthcare for a rapidly changing world. Our brand is anchored in our values, with heart at its center, and our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Mission
At CVS Health, we believe that everyone who works with us should feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make healthcare more personal, convenient, and affordable. Our Heart At Work Behaviors support this purpose, and we are committed to creating a work environment that is inclusive, diverse, and supportive of our employees' growth and development.
Job Summary
We are seeking an experienced Full Stack Utilization Management Nurse Consultant to join our team. This is a fully remote position, and the successful candidate will have the opportunity to work from anywhere in the United States. As a Utilization Management Nurse Consultant, you will utilize your clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. You will be responsible for ensuring that members receive the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times.
Key Responsibilities
- 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.
- Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
- 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
To be successful in this role, you will need to have the following qualifications:
Essential Qualifications
- Active current and unrestricted RN licensure in the state of residence.
- 2+ years of clinical experience as an RN (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more).
- Ability to work Monday through Friday 8:30am-5:00pm in the time zone of residence. Shift times may vary occasionally per the need of the department.
- Ability to work a late shift requirement until 9:00pm EST based on the needs of the business.
- Ability to work a weekend shift requirement per the needs of the team.
- Ability to work Holiday rotation per the need of the department (typically 1 holiday per year).
- 1+ years' experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook).
Preferred Qualifications
- 1+ years' experience in Utilization Review.
- 1+ years' experience in Managed Care.
- Strong telephonic communication skills.
- Experience with computers toggling between screens while using a keyboard and speaking to customers.
- Ability to exercise independent and sound judgment, strong decision-making skills, and well-developed interpersonal skills.
- Ability to manage multiple priorities, effective organizational and time management skills required.
- Ability to use a computer station and sit for extended periods of time.
Education
An Associate's degree is required, and a BSN is preferred.
Compensation and Benefits
The typical pay range for this role is $26.01 - $56.14 per hour. 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.
In addition to your compensation, you will enjoy the rewards of an organization that puts its heart into caring for its colleagues and communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
Career Growth Opportunities and Learning Benefits
We are committed to creating a work environment that is inclusive, diverse, and supportive of our employees' growth and development. As a CVS Health employee, you will have access to numerous learning and development opportunities, including training programs, mentorship, and career advancement opportunities.
Work Environment and Company Culture
We are a dynamic and innovative company that is committed to creating a work environment that is inclusive, diverse, and supportive of our employees' growth and development. Our company culture is built on our Heart At Work Behaviors, which include:
- Putting the customer at the center of everything we do.
- Being passionate about making a difference in the lives of our customers and colleagues.
- Being accountable for our actions and our results.
- Being open, honest, and transparent in all our interactions.
- Being respectful and inclusive of all individuals.
- Being adaptable and flexible in a rapidly changing environment.
How to Apply
If you believe you have what it takes to be a successful Utilization Management Nurse Consultant, submit your application without delay. We are keen to hear from talented candidates like you.
Apply for this job