Utilization Management Nurse Consultant - Florida Registered Nurse License Required

Hispanic Alliance for Career Enhancement; Tallahassee (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health solutions company seeks a Utilization Management Nurse Consultant to coordinate care and ensure members receive appropriate services. This remote role requires an active RN license in Florida and offers competitive pay and benefits, including a 401(k) plan and wellness programs.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

No-cost wellness programs

Tuition assistance

Qualifications

• 3+ years of clinical practice experience in an inpatient setting required.
• Active RN licensure in Florida.
• Willingness to obtain additional state licenses.

Responsibilities

• Coordinate, document, and communicate utilization management.
• Evaluate and facilitate appropriate healthcare services.
• Consult with providers to optimize care.

Skills

Clinical coordination

Critical thinking

Communication

Education

Associate's degree

BSN

Job description

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 schedule may include weekends, holidays and evening hours.

This role is work from home anywhere in the state of Florida. Applicant must reside in Florida.

As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.

- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage
determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
- Identifies members who may benefit from care management programs and facilitates referral
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

Required Qualifications

- 3+ years of clinical practice experience in an inpatient setting required

- Must have active current and unrestricted RN licensure in state of Florida

- Willingness to obtain additional state licenses as needed (paid for by company)

- Must reside in Florida

Preferred Qualifications
- Previous Utilization Management and/or Managed Care experience preferred

- Discharge planning 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 - $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: 05/31/2025

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