Nurse Consultant, Utilization Management

Description: Medicare Complex Spine Precertification Nurse Consultant position: Utilization Management is a 24/7 operation and work schedules will include holidays and evening hoursUtilizes 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/treatmentIdentifies members for referral opportunities to integrate with other products, services and/or programsIdentifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilizationConsults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Requirements: 3+ years of experience as a Registered NurseMust have active current and unrestricted RN licensure in state of residence1+ years of Med/Surg experience1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)Must be willing and able to work Monday through Friday, 9:00am to 5:30pm EST with occasional holiday rotation. Prior Authorization or Utilization Management experience (preferred)Managed care experience (preferred)Experience using MedCompass (preferred)Ambulatory surgery experience (preferred) Benefits: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits Apply tot his job Apply To this Job