Utilization Management Nurse Consultant

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🔥 2 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Coordinate, document and communicate all aspects of the utilization/benefit management program • Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply appropriate clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations or recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services and programs • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization • Consult and lend expertise to internal and external constituents in coordinating and administering the utilization/benefit management function • Review services for medical necessity and appropriate benefit utilization • Facilitate safe and efficient discharge planning • Work with facilities and providers to meet complex member needs • Review written clinical records • Minimal travel, potentially up to 10%, may be required for clinical audits

🎯 Requirements

• Must have an active, current and unrestricted RN license in state of residence • 2+ years of recent acute hospital clinical experience as an RN, with recent defined as within the past 10 years • 1+ years of experience with Microsoft Office including PowerPoint, Excel, and Word • Must be willing and able to work Monday through Friday 8:00am-4:30pm in the time zone of residence • Must be willing and able to work weekend and holiday rotation per the needs of the department • Utilization Review experience preferred • Managed Care background preferred • Strong telephonic communication skills preferred • Associates Degree in Nursing required • Bachelor’s in Science & Nursing preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility

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