Utilization Management Nurse Consultant

at  CVS Health

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 Behaviors™ 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 SUMMARY

Utilization Management is a 24/7 operation and work schedule is for every weekend and 2 week days ( 4/10 hour shifts weekly) may include holidays and evening hours.
Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.

REQUIRED QUALIFICATIONS

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in VA or compact licensure
• Must possess 1+ years of clinical experience in acute or post-acute setting
• Weekend Role: candidates must be able to work 8:00am-5:00pm EST, Saturday, Sunday and 2 weekdays.

PREFERRED QUALIFICATIONS

• Discharge planning experience
• Utilization Management experience
• Previous prior authorization experience

EDUCATION

• Associates degree or Nursing Diploma required
• BSN preferred

Please refer the Job description for details