Utilization Management Nurse Consultant

The Muse; Richmond (VA); On-site; Full time

Job summary

A leading health solutions company is seeking an Utilization Management Nurse Consultant to join their dynamic team. The role involves assessing healthcare services to optimize member benefits and requires strong clinical judgment. Ideal candidates will have a solid background in acute care nursing and a passion for delivering quality healthcare solutions. This full-time position offers competitive pay and comprehensive benefits.

Benefits

Affordable medical plan options

401(k) plan with company matching

Employee stock purchase plan

Wellness screenings and counseling programs

Tuition assistance

Qualifications

• 2+ years as Registered Nurse in adult acute care/critical care.
• Active RN licensure in state of residence required.
• Proficiency with computer skills.
• Must adapt to fast-paced environment.

Responsibilities

• Assess and implement healthcare services for members.
• Communicate with providers for care facilitation.
• Evaluate options for coverage determination.
• Promote effective healthcare service utilization.

Skills

Communication

Clinical Judgment

Multitasking

Problem Solving

Education

Associates Degree

BSN

Tools

Clinical Software

Job description

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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. 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

• 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 and work schedules will include weekends, holidays, and evening hours.
  
  

Preferred Qualifications

• 2+ years of clinical experience required in med surg or specialty area.
• Managed Care experience preferred, especially Utilization Management.
• Preference for those residing in ET zones.
  
  

Education

• Associates Degree required
• BSN preferred
  
  

Anticipated Weekly Hours

40Time Type

Full timePay Range

The typical pay range for this role is:$26.01 - $74.78This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 07/01/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Technology, Information and Internet

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