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Utilization Management Nurse Consultant

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States, New Jersey

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Category:
Nursing

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Contract Type:
Employment contract

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Salary:

34.92 - 74.78 USD / Hour
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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. Utilizes clinical experience to manage and evaluate healthcare services for members in a remote professional role.

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
  • Sedentary work involving periods of sitting, talking, listening
  • Work requires sitting for extended periods, talking on the telephone and typing on the computer
  • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

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 Eastern Time zones
What we offer:
  • Affordable medical plan options
  • 401(k) plan with 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 19, 2025

Expiration:
April 30, 2025

Employment Type:
Fulltime
Work Type:
Remote work
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