Job Information
CVS Health Utilization Management Nurse Consultant- Medical Review in Columbus, Ohio
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
This position will be remote working from home anywhere in the US.
Schedule is Monday - Friday 8am-5pm est.
No travel required.
Non-exempt. Hourly. Pay: Bi-weekly. No shift premium.
Occasional Overtime may be required.
Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases .
Applies the appropriate clinical criteria/guideline to render a medical determination to the client.
Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.
For more information on our benefit programs, please visit
https://jobs.cvshealth.com/employee-benefits (https://protect-usb.mimecast.com/s/HChtCEKL7mupo2P4Q84HN2Ovk?domain=jobs.cvshealth.com)
Required Qualifications:
-3+ Years of clinical experience
-1+ Year of Utilization Review Management and/or Medical Management experience.
-Must have active and unrestricted RN license in the state you reside.
-5 years demonstrated to make thorough independent decisions using clinical judgement
-5 Years proficient use of equipment experience including phone, computer, etc and clinical documentation systems
-Required to attend all classes the first 3 weeks of initial training required with 100% participation during 8:00am-5pm Monday-Friday
Preferred Qualifications:
- MCG Milliman, InterQual, or other guideline application Experience
Education:
Associate Degree required.
BSN preferred.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$26.01 - $56.14
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 customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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
We anticipate the application window for this opening will close on: 03/18/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.