Utilization Management Nurse Consultant
Company: CVS Health
Location: Atlanta
Posted on: October 8, 2024
Job Description:
Bring your heart to CVS Health. Every one of us at CVS Health
shares a single, clear purpose: Bringing our heart to every moment
of your health. This purpose guides our commitment to deliver
enhanced human-centric health care for a rapidly changing world.
Anchored in our brand - with heart at its center - our purpose
sends a personal message that how we deliver our services is just
as important as what we deliver.Our Heart At Work BehaviorsTM
support this purpose. We want everyone who works at CVS Health to
feel empowered by the role they play in transforming our culture
and accelerating our ability to innovate and deliver solutions to
make health care more personal, convenient and affordable.Position
SummaryUtilization 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 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.
- Work requires the ability to perform close inspection of hand
written and computer generated documents as well as a PC
monitor.
- Sedentary work involving periods of sitting, talking,
listening.
- Work 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.
- Position requires proficiency with computer skills which
includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and writtenRequired
Qualifications
- 3+ years of experience as a Registered Nurse
- Must have active current and unrestricted RN licensure in state
of residence
- 1+ years of clinical experience in acute or post acute
setting
- Utilization management is a 24/7 operation. Work schedules will
include a minimum of 6 weekend rotations per year, as well as
holidays and evening rotations.
- Candidates must be willing and able to work Mon-Fri 8:30am-5pm
or 10:30 am - 7pm in time zone of work being supported. Utilization
Management is a 24/7 operation and work schedule may include
weekends, holidays and evening hoursPreferred Qualifications
- 3+ years of clinical experience required
- Managed Care experience preferredEducationAssociates DegreeBSN
preferredPay RangeThe Typical Pay Range For This Role Is$26.01 -
$56.14This 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.In addition to your compensation,
enjoy the rewards of an organization that puts our heart into
caring for our colleagues and our communities. The Company offers a
full range of medical, dental, and vision benefits. Eligible
employees may enroll in the Company's 401(k) retirement savings
plan, and an Employee Stock Purchase Plan is also available for
eligible employees. The Company provides a fully-paid term life
insurance plan to eligible employees, and short-term and long term
disability benefits. CVS Health also offers numerous well-being
programs, education assistance, free development courses, a CVS
store discount, and discount programs with participating partners.
As for time off, Company employees enjoy Paid Time Off ("PTO") or
vacation pay, as well as paid holidays throughout the calendar
year. Number of paid holidays, sick time and other time off are
provided consistent with relevant state law and Company
policies.For more detailed information on available benefits,
please visit Benefits - CVS HealthWe anticipate the application
window for this opening will close on: 10/08/2024Qualified
applicants with arrest or conviction records will be considered for
employment in accordance with all federal, state and local
laws.
Keywords: CVS Health, Johns Creek , Utilization Management Nurse Consultant, Executive , Atlanta, Georgia
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