Utilization Management Nurse Consultant

Description: • Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program and our plan sponsor(s). • Ensure the member is receiving the appropriate care, at the appropriate time, and at the appropriate location using designated criteria, while adhering to federal and state regulated turn-around times. • Review written and electronic clinical records. • Review services to assure medical necessity, apply clinical expertise to assure appropriate benefit utilization, facilitate safe and efficient discharge planning, and work closely with facilities and providers to meet complex needs of the member. • Work closely with facilities and providers to meet complex needs of the member. Requirements: • Must have active current and unrestricted RN license in state of residence • 3+ years of acute hospital clinical experience as an RN • Must be able to work Monday through Friday 8am to 5pm EST zone with occasional on-call weekend and holiday rotation per business needs • 1+ years of MS Office suites experience including Outlook and Excel • Associate’s Degree in Nursing or Diploma RN required; BSN preferred Benefits: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. • Eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Apply tot his job Apply To this Job