Salary: $26.01 – $68.55 per hour
AI-generated summary of the employer’s posting. Always check the full description below before applying.
What They’re Looking For
Candidates must have at least 3 years of experience as a Registered Nurse with an active, unrestricted license and 1 year of Med/Surg experience. Proficiency in Microsoft Office applications and the ability to work specific weekend and evening shifts are required.
Skills to Showcase on Your Resume
Utilization management, Clinical assessment, Medicare, Care coordination, Prior authorization, Managed care, Med/Surg nursing, Clinical criteria application, MedCompass, Microsoft Office, Outlook, Teams, Excel, Healthcare services, Patient advocacy, Quality effectiveness
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
Medicare Predetermination Utilization Management Nurse Consultant position:
Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
- 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.
Required Qualifications
- 3+ years of experience as a Registered Nurse
- Must have active current and unrestricted RN licensure in state of residence
- 1+ years of Med/Surg experience
- 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
- Must be willing and able to work Saturday, Sunday, Monday and Tuesday 10 hr shifts after approx 4-5 months of training Monday – Friday 7:30am-6pm EST with occasional holiday rotation.
Preferred Qualifications
- Prior Authorization or Utilization Management experience
- Managed care experience
- Experience using MedCompass
- Ambulatory surgery experience
- Medicare experience is a must
Education
Associates degree required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 – $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.