Nurse Consultant, Utilization Management: Improve Care

RiseMe; Chandler (AZ); On-site; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Job summary

CVS Health is seeking a 24/7 Utilization Management RN in Chandler, AZ. The role involves collaboration to assess and coordinate care, apply clinical guidelines for coverage determinations, and communicate with providers to optimize member care and benefit utilization.

The position requires 2+ years of acute/critical care nursing, active RN licensure, and flexibility for evenings, weekends, and holidays. Comprehensive benefits and career growth opportunities are offered.

Qualifications

• 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 with weekends/holidays/evenings.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Gather clinical information and apply criteria/guidelines for coverage determinations.
• Communicate with providers and others to facilitate care and identify referral opportunities.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal and external stakeholders in utilization/benefit management.

Skills

Registered Nurse

Utilization Management

Clinical Coordination

Effective communication

Education

Active RN licensure

Job description

CVS Health is seeking a 24/7 Utilization Management RN in Chandler, AZ. The role involves collaboration to assess and coordinate care, apply clinical guidelines for coverage determinations, and communicate with providers to optimize member care and benefit utilization.

The position requires 2+ years of acute/critical care nursing, active RN licensure, and flexibility for evenings, weekends, and holidays. Comprehensive benefits and career growth opportunities are offered.