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Utilization Management Nurse Consultant – Weekends, S/S/M/T (4-10 hour shifts)
CVS Health Careers. Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management and Prior Authorization processes, with a strong focus on clinical assessment and effective communication with healthcare providers. Holds active RN licensure and possesses experience in Medicare and Managed Care environments.
Highest-signal resume keywords
Registered Nurse LicensureUtilization Management ExperienceMedicare ExperienceClinical Assessment SkillsMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical JudgmentCoverage DeterminationCare CoordinationBenefit ManagementMed/Surg ExperienceAmbulatory Surgery ExperiencePrior AuthorizationHealthcare Service Quality PromotionClinical Criteria ApplicationEvaluation of Healthcare Services
Soft Skills
Effective CommunicationCollaborationProblem-SolvingInterpersonal SkillsOrganizational Skills
Tools & Technologies
Microsoft OfficeMedCompass
Certifications & Qualifications
Active RN LicensureAssociates DegreeBSN Preferred
Industry Keywords
Managed CareMedicareUtilization ManagementHealthcare ServicesClinical Guidelines
About the role
Key responsibilities & impact- Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members
- Gather clinical information and apply clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations or recommendations
- Communicate with providers and other parties to facilitate care and treatment
- Identify members for referral opportunities involving other products, services and programs
- Identify opportunities to promote healthcare service quality and effective benefit utilization
- Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
- Participate in a 24/7 utilization management operation, including holidays and evening hours
Requirements
What you’ll need- 3+ years of experience as a Registered Nurse
- Active, current and unrestricted RN licensure in state of residence
- 1+ years of Med/Surg experience
- 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
- Willingness and ability to work Saturday, Sunday, Monday and Tuesday 10-hour shifts after approximately 4–5 months of Monday–Friday training, 7:30am–6pm EST, with occasional holiday rotation
- Prior Authorization or Utilization Management experience preferred
- Managed care experience preferred
- Experience using MedCompass preferred
- Ambulatory surgery experience preferred
- Medicare experience required
- Associates degree required
- BSN preferred
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay