Utilization Management Nurse Consultant (Weekends - CST)

The Muse; Oklahoma City (OK); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading health solutions company seeks a Utilization Management Nurse Consultant for weekends. In this role, you will assess and coordinate healthcare services, facilitate provider communication, and leverage your nursing expertise to improve patient outcomes. Join a dynamic team dedicated to transforming health care in a collaborative environment.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Confidential counseling services

Tuition assistance

Qualifications

• Registered Nurse in state of residence.
• 3+ years of Nursing experience.
• Prior authorization utilization management/review experience preferred.

Responsibilities

• Utilizes clinical experience to assess and implement appropriate healthcare services.
• Gathers clinical information for coverage determination.
• Identifies referral opportunities to integrate with other programs.

Skills

Nursing

Clinical judgment

Communication

Education

Associates Degree in Nursing

BSN preferred

Job description

Join to apply for the Utilization Management Nurse Consultant (Weekends - CST) role at The Muse

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Join to apply for the Utilization Management Nurse Consultant (Weekends - CST) role at The Muse

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.Hours of operation/Work schedule Friday/Saturday/Sunday/Monday 10 hour shifts. First 6 months of training will be M-F 8-5 CST.

• 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.
  
  

Required Qualifications

• Registered Nurse in state of residence.
• 3+ years of Nursing experience.
  
  

Preferred Qualifications

• Prior authorization utilization management/review experience preferred Outpatient Clinical experience.
• Knowledge of Medicare/Medicaid Managed care experience
  
  

Education

• Associates Degree in Nursing
• BSN preferred
  
  

Anticipated Weekly Hours

40Time Type

Full timePay Range

The typical pay range for this role is:$26.01 - $68.55This 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: 06/14/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Technology, Information and Internet

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