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Nurse Consultant
CVS Health. Coordinate, document, and communicate all aspects of the utilization/benefit management program .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management, including conducting reviews and assessments, developing care plans, and optimizing healthcare resources. Holds an active RN license and possesses strong clinical judgment, decision-making skills, and the ability to communicate effectively with diverse stakeholders.
Highest-signal resume keywords
RN LicenseUtilization Review ExperienceAcute Hospital Clinical ExperienceMedical Terminology KnowledgeTelephonic Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementClinical AssessmentCare CoordinationMedical Record ReviewDecision-Making SkillsDigital Literacy SkillsHealthcare Resource OptimizationCompliance ReviewDischarge PlanningClinical Judgment
Soft Skills
Interpersonal SkillsOrganizational SkillsTime Management SkillsTactful CommunicationCultural Competence
Tools & Technologies
Microsoft Office SuiteElectronic Health Records
Certifications & Qualifications
Active RN LicenseAssociate Degree in Nursing
Industry Keywords
Utilization Management ProgramHealthcare QualityCost-Effective AllocationMultidisciplinary TeamsHealthcare ComplianceClinical GuidelinesManaged Care
About the role
Key responsibilities & impact- Coordinate, document, and communicate all aspects of the utilization/benefit management program
- Drive effective utilization management practices and ensure appropriate, cost-effective allocation of healthcare resources
- Conduct routine utilization reviews and assessments using evidence-based criteria and clinical knowledge
- Evaluate medical necessity and appropriateness of requested healthcare services
- Collaborate with healthcare providers, multidisciplinary teams, and payers to develop and implement care plans
- Review and analyze medical records, treatment plans, and documentation for compliance with guidelines, policies, and regulations
- Provide recommendations for care coordination and resource optimization
- Communicate with internal and external stakeholders to facilitate care coordination and address utilization management inquiries
- Provide coaching and guidance to nursing staff and healthcare professionals
- Develop and implement utilization management strategies, policies, and procedures
- Facilitate safe and efficient discharge planning
- Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations or recommendations
- Identify referral opportunities and opportunities to improve healthcare quality and benefit utilization
Requirements
What you’ll need- RN with active and unrestricted state licensure in their state of residence
- 2+ years of acute hospital clinical experience as an RN
- Preference for medical-surgical and ICU experience
- Applicants whose only acute care experience is in behavioral health are not accepted
- Working knowledge of problem solving and decision making skills
- Working knowledge of medical terminology
- Working knowledge of digital literacy skills
- Ability to deal tactfully with customers and community
- Ability to handle sensitive information ethically and responsibly
- Ability to consider relative costs and benefits of potential actions
- Ability to function in clinical settings with diverse cultural dynamics
- Associate Degree in Nursing is minimum required; BSN preferred
- Preferred: 1+ years’ Utilization Review experience
- Preferred: 1+ years’ Managed Care experience
- Strong telephonic communication skills
- Preferred: 1+ years’ experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook)
- Experience using a computer while toggling between screens, keyboarding, and speaking to customers
- Independent and sound judgment and strong decision-making skills
- Well-developed interpersonal skills
- Ability to manage multiple priorities and effective organizational and time management skills
- Ability to use a computer station and sit for extended periods of time
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility