Title: Utilization Management Review Consultant (Weekend)

Location: Austin Texas United States of America

Job Description:

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

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

This is a full-time remote Utilization Review opportunity.

Working hours are four 10hr days including every Weekend, both Saturday and Sunday, and two weekday shifts of 10hrs each (Monday, Tuesday, Wednesday,Thursday or Friday). Also includes holiday and late rotations.

12.5% Shift Premium applies once M-F training schedule completed and UM Nurse Consultant participating in non-traditional, weekend shift rotation.

As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.

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.

Typical office working environment with productivity and quality expectations.

Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

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

Must have active current and unrestricted RN licensure in state of residence

Willing and able to obtain additional Nursing Licenses as business needs require

3+ years of experience as a Registered Nurse

1+ years of clinical experience in acute or post-acute setting

Must be willing and able to work four 10hr days including every Weekend, both Saturday and Sunday, and two weekday shifts of 10hrs each in time zone of residence; Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

12.5% Shift Premium applies once Monday through Friday training schedule completed and UM Nurse Consultant participating in non-traditional, weekend shift rotation

Preferred Qualifications

Critical care experience i.e. ICU, CCU, NICU, ER

Utilization review experience

Managed Care experience

Experience working with MS office applications such as Teams, Outlook, Excel, and Word

Education

Associates Degree or Nursing Diploma Required

BSN Preferred

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.

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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