Utilization Management Nurse Consultant

CVS Health; Columbus (OH); On-site; Full time

Job summary

Join a leading health solutions company seeking a Utilization Management Nurse Consultant. In this role, you will utilize your clinical expertise to assess and coordinate care for members, ensuring effective healthcare services are provided. Ideal candidates will have significant experience in a clinical setting and possess strong communication skills. This full-time position, requiring weekend and holiday rotations, offers competitive pay, flexible work hours, and comprehensive benefits. Apply today to make a difference in health care!

Benefits

401(k) plan with company matching

Employee stock purchase plan

Wellness programs and counseling

Paid time off and flexible schedules

Tuition assistance

Qualifications

• Must have active RN licensure in state of residence.
• 3+ years of clinical experience in a hospital setting.
• Utilization review experience preferred.

Responsibilities

• Assess, plan and coordinate healthcare services.
• Render coverage determination based on clinical guidelines.
• Communicate effectively with providers and healthcare staff.

Skills

Clinical assessment

Effective communication

Care coordination

Education

Associate's Degree in Nursing

BSN preferred

Job description

Join to apply for the Utilization Management Nurse Consultant role at CVS Health

Join to apply for the Utilization Management Nurse Consultant role at CVS Health

Get AI-powered advice on this job and more exclusive features.

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.

Position Summary

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

• 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.
• Typical office working environment with productivity and quality expectations.
• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
• 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.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written
  
  

Required Qualifications

• Must reside in ET zone
• 3+ years of clinical experience as a Registered Nurse in a hospital setting including Medical/Surgical, Emergency room, Critical Care, ICU, and/or step-down unit
• Must have active current and unrestricted RN licensure in state of residence
• 2+ years of clinical experience in acute or post-acute setting
• Must be willing and able to work Monday through Friday, 8:00am to 5:00pm EST with a late shift rotation 10:30am to 7pm EST. Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations.
  
  

Preferred Qualifications

• Utilization review experience
• Medicare experience
• Managed Care experience especially Utilization Management
• Proficiency with computer skills which includes navigating multiple systems and keyboarding
  
  

Education

Associate's Degree in Nursing required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$26.01 - $56.14

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

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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: 06/03/2025

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at CVS Health by 2x

Get notified about new Nursing Consultant jobs in Columbus, OH.

Columbus, OH $54,095.00-$142,576.00 2 days ago

Case Manager RN - Registered Nurse Maternity/Fertility

Columbus, OH $54,095.00-$142,576.00 2 days ago

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

Registered Nurse – Telemetry - Travel - (Tele RN)

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.