Utilization Management Clinical Nurse Consultant - Prior Authorization

Hispanic Alliance for Career Enhancement; Remote; EUR 80.000 - 100.000; Vollzeit

Zusammenfassung

A leading health solutions provider seeks a Registered Nurse to apply critical clinical knowledge in patient care. The role requires 3+ years of clinical experience and an active Arizona RN license. Responsibilities include coordinating care, evaluating health services, and managing care referrals. The position offers full-time hours with a flexible 10-hour shift schedule. Comprehensive benefits and opportunities for growth are part of the offer, making this a rewarding position for those passionate about healthcare.

Leistungen

Affordable medical plan options

401(k) with company match

Employee stock purchase plan

Wellness screenings and counseling

Qualifikationen

• Must have 3+ years of clinical practice experience.
• Active RN licensure in Arizona or Compact RN licensure required.
• Ability to work 10-hour shifts.

Aufgaben

• Apply clinical knowledge for care and treatment decisions.
• Coordinate with providers for optimal patient care.
• Identify members for additional care management services.

Kenntnisse

Critical thinking

Clinical expertise

Care coordination

Communication

Ausbildung

Associate's degree

Jobbeschreibung

Position Summary

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. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Duties include (but are not limited to)

• Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care.
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members.
• Coordinates and communicates with providers and other parties to facilitate optimal care/treatment.
• Identifies members who may benefit from care management programs or other post discharge programs and facilitates referrals.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Required Qualifications

• 3+ years of experience in clinical practice.
• Ability to work 10‑hour shifts, 4‑days per week, with rotating days (including some weekends & holidays), supporting Arizona Time Zone.
• Must have an active and unrestricted RN (Registered Nurse) licensure in the state of Arizona or Compact RN licensure.

Preferred Qualifications

• Resides in one of the following time zones: MST (Mountain Standard Time), AZ (Arizona), or PST (Pacific Standard Time).
• Previous experience with prior authorization.
• Previous experience with utilization management.
• Previous experience in an acute care setting.
• Previous clinical experience in Emergency Department, Home Health, ICU (Intensive Care Unit), Telemetry, or Medical/Surgical.
• Bachelors of Science in Nursing.

Education

• Associate's degree.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $74.78

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 every colleague feels valued and that they belong.

Great benefits for great people

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 12/31/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.