Utilization Management Nurse Consultant - Weekends S/S/M/T (4-10 hour shifts)

CVS Health; Georgia; Híbrido; USD 36.000 - 94.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Medicare Predetermination Utilization Management Nurse Consultant. The role leverages clinical experience to assess, plan, implement, coordinate, and evaluate options to ensure appropriate healthcare services and benefits for members.

The position operates in a 24/7 utilization management environment with training and may require holidays and evening hours. Ideal candidates have RN licensure, 3+ years RN, Med/Surg experience, and proficiency with Microsoft Office; weekend

Formación

• 3+ years of experience as a Registered Nurse.
• Must have active, unrestricted RN licensure in state of residence.
• 1+ years of Med/Surg experience.
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel).
• Willingness to work Saturday, Sunday, Monday and Tuesday 10 hr shifts after approx 4-5 months of training.
• Monday - Friday 7:30am-6pm EST with occasional holiday rotation.

Responsabilidades

• Assess, plan, implement, coordinate, monitor and evaluate utilization management options for members.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other programs.
• Promote quality and effectiveness of healthcare services and benefit utilization.

Conocimientos

RN experience

Med/Surg experience

Weekend availability

Educación

Associate degree

BSN preferred

Herramientas

Microsoft Office

Outlook

Excel

Teams

Descripción del empleo

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary Medicare Predetermination Utilization Management Nurse Consultant position: Utilization Management is a 24/7 operation and work schedules will include 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.

Required Qualifications

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
• Must be willing and able to work Saturday, Sunday, Monday and Tuesday 10 hr shifts after approx 4-5 months of training
• Monday - Friday 7:30am-6pm EST with occasional holiday rotation.

Preferred Qualifications

• Prior Authorization or Utilization Management experience
• Managed care experience
• Experience using MedCompass
• Ambulatory surgery experience
• Medicare experience is a must
• Education Associates 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.

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility

We anticipate the application window for this opening will close on: 11/09/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.