Utilization Management Nurse Consultant

CVS Health; Jefferson City (MO); Remote; Full time

Job summary

Un leader dans la santé propose un poste de Consultant en Gestion de L'Utilisation dans un environnement de travail à distance. Le candidat idéal apportera leur expertise clinique pour coordonner les services d'infertilité, travailler en collaboration avec les professionnels de santé et superviser l'utilisation des prestations. Une formation préalable en soins infirmiers et une licence RN sont nécessaires, et l'environnement de travail favorise le bien-être des employés avec des avantages compétitifs.

Benefits

Plan médical abordable

Plan 401(k) avec contributions de l'entreprise

Accès à des programmes de bien-être gratuits

Assistance financière et counseling

Congés payés et horaires flexibles

Qualifications

• Infirmier enregistré avec 3 ans d'expérience.
• Licences RN actives et sans restrictions.
• Expérience dans la gestion des services de santé souhaitée.

Responsibilities

• Évaluation et coordination des services d'infertilité.
• Application des critères cliniques pour déterminer la couverture.
• Communication avec les fournisseurs pour faciliter les soins.

Skills

Rapidité d'analyse

Communication

Collaboration

Education

Associate's degree

BSN preferred

Tools

MS Office

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

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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.

This is a full-time remote position.

Position Summary

Precertification (Infertility): Utilization Management Nurse Consultant

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate infertility services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determinations/recommendations 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.
  
  

Required Qualifications

• 3+ years of acute experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• Must be willing and able to work Monday through Friday, 8am to 5pm in time zone of residence
• Must be willing and able to work holiday and weekend rotation per business needs
• 1+ years of MS Office suite experience
  
  

Preferred Qualifications

• Precertification/Utilization Management experience
• Infertility experience
  
  

Education

• Associate's degree required
• BSN preferred
  
  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$26.01 - $68.55

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: 07/01/2025

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

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