Utilization Management Nurse Consultant (Weekend)

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. • Schedule:   This is an Alternative Work   Schedule   weekend position. The role requires coverage of both Saturday and Sunday each week.   Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs.   Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.     Position Summary:   Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to   facilitate   appropriate healthcare   services and benefits for members.     Key Responsibilities:     * Gather clinical information and apply the   appropriate clinical   criteria, guidelines, policies, procedures, and clinical judgment to   render   coverage determinations and recommendations along the continuum of care.   * Communicate with providers and other parties to   facilitate   care and treatment.   Identify   members for referral opportunities to integrate with other products, services, or benefit programs.   *   Identify   opportunities to promote quality and effectiveness of healthcare services and benefit   utilization .   * Consult and lend   expertise   to other internal and external constituents in the coordination and administration of the utilization/benefit management function.   * Meet set productivity and quality expectations as   established   by UMNC.     Required Skills and Abilities:     * Effective verbal and written communication skills.   *   Proficiency   with computer skills, including navigating multiple systems and keyboarding.   * Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.   * Capacity to sit for extended periods, talk on the telephone, and type on the computer.     Work Location:     This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the   office or client location may be   required   for meetings, training sessions, or other events as directed.     ` Required Qualifications   • Registered Nurse    • Education:   Diploma RN   acceptable;   Associate degree / BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting ,   and    1 + years of Utilization Management / Care   Manage ment   Experience     • Must have active current and unrestricted RN licensure in state of residence.     • May be   required   to obtain   additional   Nursing Licenses as business needs   require.     *   Preferred Qualifications   -   Utilization   Management experience preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.    Our people fuel our future. Our teams reflect the cu