Job Description

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

Pay Range:

• The typical pay range for this role is: $26.01 - $74.78
• This pay range represents the base hourly rate or base annual full-time salary. The actual base salary offer will depend on factors like experience, education, and geography.
• This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay.

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Position Overview

At CVS Health, we are building a world of health around every consumer and are seeking dedicated colleagues passionate about transforming healthcare. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and over 300,000 purpose-driven colleagues. We care for people where, when, and how they choose, in a uniquely connected, convenient, and compassionate way.

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

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Responsibilities

• Utilize 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.
• Gather clinical information and apply appropriate clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products, services, and/or programs.
• Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Work in a typical office environment with productivity and quality expectations.
• Perform close inspection of handwritten and computer-generated documents and PC monitor.
• Engage in sedentary work involving periods of sitting, talking, and listening.
• Sit for extended periods, talk on the telephone, and type on the computer.
• Ability to multitask, prioritize, and effectively adapt to a fast-paced, changing environment.
• Demonstrate proficiency with computer skills, including navigating multiple systems and keyboarding.
• Utilize effective communication skills, both verbal and written.

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Required Qualifications

• A minimum of 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting.
• Must possess an active, current, and unrestricted RN license in your state of residence.

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Preferred Qualifications

• 2+ years of clinical experience in a med-surg or specialty area.
• Managed Care experience is preferred, especially in Utilization Management.
• Preference for candidates residing in EST or CST time zones.

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Education

• Associate's degree in nursing is required.
• Bachelor of Science in Nursing (BSN) is preferred.

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Company Information & Benefits

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 belongs.

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 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.