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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
Precertification : Utilization Management Nurse Consultant
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, procedures to render precertification coverage determinations or make recommendations to Medical Directors
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 benefit utilization
Typical office working environment with productivity and quality expectations
Sedentary work involving periods of sitting, talking, listening
Work requires sitting for extended periods, talking on the telephone and typing on the computer
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written
Required Qualifications
3+ years of experience as a Registered Nurse
Must have active current and unrestricted RN licensure in state of residence
3+ year(s) of Med / Surg experience
3+ year(s) of experience with Microsoft Office applications (Outlook, Teams, Excel)
Must be able to work Monday through Friday 9 : 00am to 6 : 00pm in time zone of residence with occasional holiday rotation per business needs
Must be able to work evening late shift up to 8 : 00pm EST zone (twice per month)
Preferred Qualifications
Prior Authorization or Utilization Management experience
Managed care experience
MedCompass & Medicare experience
Education
Associates degree required
BSN preferred
Pay Range
The typical pay range for this role is :
$26.01 - $62.31
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.
The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.
The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.
CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.
Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
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