UM Clinical Consultant

Employment Type: Full time Anticipated Weekly Hours: 40 Time Type: Full time

Position Overview

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.

Candidates from any state are welcome to apply!

Working hours will be 8am-5pm Monday - Friday (Arizona Time). Must be willing and able to work on Arizona time zone. No weekends, holidays are required.

The UM Clinical Consultant utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care. Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members.

Responsibilities

• Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.
• Identifies members who may benefit from care management programs or other post discharge programs and facilitates referrals.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Requirements

• 3+ years acute hospital clinical practice experience
• Must have an active and unrestricted RN Licensure in the state of Arizona or Compact RN licensure
• Working hours will be 8am-5pm, Monday - Friday (Arizona Time). Must be willing and able to work on Arizona time zone. No weekends, holidays are required.

Preferred Qualifications

• Utilization management experience
• Clinical experience in Emergency Department, ICU, Telemetry, and/or Medical / Surgical

Education

• Minimum of Associate degree in Nursing required

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.

Company Information

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)
• 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.