Utilization Management Nurse Consultant Afternoon Shift | Urgent Hiring
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 100% remote position from anywhere in the U.S. Schedule is Monday-Friday 1130am 8pm EST for a minimum of 1 year post training/onboarding. MUST have the ability to work the occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage (URAC and Client Requirements). Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient requiring precertification. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Position requires proficiency with computer skills which includes navigating multiple systems. Sedentary work involves periods of sitting, talking, listening and computer use . Required Qualifications 1 year varied Utilization Management experience within an Inpatient/Outpatient setting, concurrent review or prior authorization. 5 years of variety clinical experience required including acute care, home health, or long term care. 5 years Demonstrated to make thorough independent decisions using clinical judgement 5 Years Proficient use of equipment experience including phone, computer, etc and clinical documentation systems Required to attend the first 3 weeks training with 100% participation during 8:30am-5pm Monday-Friday. A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and can be licensed in all noncompact states Preferred Qualifications 1+ years Managed Care (MCO) preferred 1+ years demonstrated experience working in a high volume clinical call center environment Remote work experience Education Associates degree in nursing (RN) required, BSN preferred Pay Range The typical pay range for this role is: $28.25 $60.50 This 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. Apply to this job Apply Job!