Utilization Management Nurse Consultant – Weekends, 4-10 Hour Shifts
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Idaho, Mississippi, North Carolina, Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $26 - $62 per hour
Job Level
Mid-LevelSenior
About the role
- Medicare Precertification Utilization Management Nurse Consultant position
- 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.
Requirements
- 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 Friday, Saturday, Sunday and Monday 10 hr shifts after approx 4-5 months of training Monday - Friday 8:30-5pm EST with occasional holiday rotation.
- Prior Authorization or Utilization Management experience preferred
- Managed care experience preferred
- Experience using MedCompass preferred
- Ambulatory surgery experience preferred
- Associates degree required
- BSN preferred
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Registered NurseMed/Surg experiencePrior AuthorizationUtilization ManagementManaged careAmbulatory surgeryClinical judgmentHealthcare servicesBenefit utilizationClinical criteria
Soft skills
collaborative processcommunicationcoordinationmonitoringevaluationconsultationquality effectivenessproblem-solvinginterpersonal skillsorganizational skills
Certifications
active RN licensureAssociates degreeBSN