UM Nurse Consultant Afternoon Shift | (Remote)

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to ever

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y moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

 

Position Summary

100% remote position from anywhere in the U.S. Work hours: 11:30am-8:00pm eastern time shift for at least first 9 months post completion of orientation period.

Required to attend the first 3 weeks training required 100% participation during 8:30am-5pm Monday-Friday.

Work in clinical telephone queue working with providers to secure additional information for prior authorization review

-Weekend/holiday coverage will occasionally be required

-This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

-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 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

1 year UM, concurrent review or prior authorization

5 years of clinical experience required

5 years Demonstrated to make thorough independent decisions using clinical judgement

Required to attend the first 3 weeks training required 100% participation during 8:30am-5pm Monday-Friday.

A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all noncompact states.

 

Preferred Qualifications

1+ years Managed Care (MCO) preferred

1+ years demonstrated experience working in a high volume clinical call center environment

Remote work experience

 

Education

Associate degree in nursing RN required.

BSN preferred.

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