Utilization Management Nurse Consultant

Company	CVS Health
Location	Kansas, USA, Pennsylvania, USA, Delaware, USA, Iowa, USA, Washington, DC, USA, Vermont, USA, Texas, USA, Jackson Township, NJ, USA, Florida, USA, Waterbury, CT, USA, South Carolina, USA, Georgia, USA, Concord, NH, USA, Mississippi, USA, Tennessee, USA, Virginia, USA, Arkansas, USA, Minnesota, USA, Rhode Island, USA, Kentucky, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, Wisconsin, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Oklahoma, USA, Missouri, USA, Ohio, USA, Indiana, USA, Louisiana, USA, Michigan, USA, Illinois, USA, Alabama, USA
Salary	$26.01 – $74.78
Type	Full-Time
Degrees	Bachelor’s
Experience Level	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.
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.