Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

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.

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours.

As a Utilization Management Nurse Consultant, you will utilize 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 judgement 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 facilities referrals. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Required Qualifications:

• Must have active, current, and unrestricted RN licensure in state of residence
• Willingness to obtain additional state licenses
• 3+ years of clinical practice experience in an inpatient setting as an RN
• 1+ years of experience with computer skills which includes navigating multiple systems and keyboarding

Preferred Qualifications:

• Knowledge or clinical practice experience in a post acute facility ( Skilled nursing, Rehabilitation, Long Term Acute Care)
• Active IL RN Licensure

Education:

• Associates degree required
• BSN preferred

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $32.01 - $68.55

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.