Utilization Management Nurse Consultant

Company	CVS Health
Location	Pennsylvania, USA, Delaware, USA, Iowa, USA, Texas, USA, Jackson Township, NJ, USA, Florida, USA, Waterbury, CT, USA, South Carolina, USA, Georgia, USA, Arizona, USA, Mississippi, USA, Tennessee, USA, Virginia, USA, Arkansas, USA, Minnesota, USA, Rhode Island, USA, West Virginia, USA, New York, NY, USA, Wisconsin, USA, North Carolina, USA, Missouri, USA, Louisiana, USA, Illinois, USA, Alabama, USA
Salary	$32.01 – $68.55
Type	Full-Time
Degrees
Experience Level	Junior, Mid Level

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Must have active current and unrestricted RN licensure in state of residence
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
Proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written

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