Utilization Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Schedule is Monday through Friday, 9:00am to 5:30pm in the candidate's time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours. Medicare Precertification Utilization Management Nurse Consultant position (complex spine): 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. Required Qualifications 3+ years of experience as a Registered Nurse Must have active current and unrestricted RN licensure in state of residence 1+ years of Med/Surg experience 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) Preferred Qualifications Prior Authorization or Utilization Management experience Managed care experience Experience using MedCompass Ambulatory sur...