Utilization Management Nurse Consultant

Join to apply for the Utilization Management Nurse Consultant role at CVS Health . This role is part of a 24 / 7 operation and will require working weekends, holidays, and evening hours.

Position Summary

Utilization Management is a 24 / 7 operation. Work schedules will include weekends, holidays, and evening hours.

Responsibilities

• 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.
• Typical office working environment with productivity and quality expectations.
• Requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
• Sedentary work involving periods of sitting, talking, listening.
• Requires sitting for extended periods, talking on the telephone and typing on the computer; ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
• Proficiency with computer skills, including navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.

Required Qualifications

Preferred Qualifications

Education

Associates Degree required. BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$26.01 - $56.14 hourly

Benefits

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.

You can learn more about our benefits at https : / / jobs.cvshealth.com / us / en / benefits.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We anticipate the application window for this opening will close on : 11 / 08 / 2025.

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