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 Must hold Illinois state RN licensure Hours: M-F; 8am - 5pm CST - Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services. - Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function - Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care - Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support) - Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment - Identifies members who may benefit from care management programs and facilitates referral - Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization Required Qualifications - Must have active, current, and unrestricted RN licensure in state of IL - Must be available to work M-F; 8am - 5pm CST - Willingness to obtain additional state licenses - 3+ years of clinical practice experience in an inpatient setting as a...