UM Nurse Consultant (Remote)

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.

Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations.

Position Summary 

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 benefit 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. 

UMNC meets set productivity and quality expectations. 

Effective communication skills, both verbal and written 

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. 

Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. 

Work requires sitting for extended periods, talking on the telephone and typing on the computer.  

Work from home position: During work hours, Colleagues who are working from home must be available by phone, videoconference, and email in a manner and frequency that is required by the Colleague's Leader. Colleagues must be available from time to time to come into the office or client location on a given day for work-related meetings, training sessions or other events, as directed by their Leader. 

Position is Monday through Friday varying hours available with Holiday, Weekend, and late rotations.  
 
Required Qualifications 

• Active and unrestricted RN licensure in state of residence. May be required to obtain additional nursing licenses as business needs require
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