Utilization Management Nurse Consultant

CVS Health; Colorado; A distancia; USD 40.000 - 85.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs and other resources

Descripción de la vacante

CVS Health is seeking a Utilization Management Nurse Consultant to assess, plan, implement, and coordinate healthcare services for members in a collaborative environment. This role leverages clinical expertise to determine coverage and support care decisions.

The position is remote with Colorado presence, full-time schedule, and requires RN licensure with 3+ years of nursing experience including Med/Surg; BSN preferred.

Formación

• Associates degree required, BSN preferred.
• 3+ years of experience as a Registered Nurse.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications.

Responsabilidades

• Assess and evaluate healthcare services for members.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services and programs.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents on utilization management functions.

Conocimientos

Clinical assessment

Care coordination

Communication with providers

Educación

Associate degree

BSN preferred

Herramientas

Microsoft Office

Descripción del empleo

About This Role

The Utilization Management Nurse Consultant at CVS Health is responsible for assessing, planning, implementing, and coordinating healthcare services for members. This role is ideal for experienced nurses looking to contribute to a collaborative healthcare environment.

Highlights

• Pay: $29.10 - $62.32/hour
• Location: Remote, CO
• Schedule: Full-time, Monday through Friday, 9:00am - 5:30pm EST or CST with occasional holiday rotation

What You'll Do

• Utilize clinical experience to assess and evaluate healthcare services for members.
• Gather clinical information and apply clinical criteria to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services and programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents on utilization management functions.

Requirements

Education

• Associates degree required, BSN preferred

Experience

• 3+ years of experience as a Registered Nurse
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications

Licenses & Certifications

• Active current and unrestricted RN licensure in state of residence required

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on fostering a workplace where every colleague feels valued and belongs, reflecting the diverse communities they serve.