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
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.
- 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 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
40Time Type
Full timePay Range
The typical pay range for this role is:
$32.01 - $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 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 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 computer skills including navigating multiple systems and keyboarding
- Associates degree
- Knowledge or clinical practice experience in a post acute facility (Skilled nursing, Rehabilitation, Long Term Acute Care)
- BSN
- Active IL RN Licensure
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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