Job summary
Job post source
This job is directly from CVS Health
Job overview
The Utilization Management Nurse Consultant at CVS Health assesses and coordinates healthcare services to ensure appropriate care and benefits for members, impacting care quality and utilization.
Responsibilities and impact
The role involves evaluating clinical information to make coverage determinations, communicating with providers, identifying referral opportunities, promoting quality healthcare services, and collaborating internally and externally to manage utilization and benefits.
Compensation and benefits
The pay range is $32.01 to $68.55 per hour with eligibility for bonuses and incentives; benefits include medical plans, 401(k) with company match, stock purchase plan, wellness programs, paid time off, flexible schedules, and tuition assistance.
Experience and skills
Requires 2+ years as a Registered Nurse in adult acute/critical care with active RN licensure; preferred experience includes med surg or specialty clinical areas and managed care, especially utilization management.
Work environment and culture
The company values diversity, inclusion, and a supportive workplace where colleagues feel valued and belong, with a focus on health and wellness.
Company information
CVS Health is a leading health solutions company with a large workforce and a mission to provide connected, convenient, and compassionate healthcare.
Job location and travel
Typical office environment with sedentary work, requiring multitasking and proficiency with computer systems; work includes weekends, holidays, and evening hours in a 24/7 operation.
Application process
Applicants must apply by 07/14/2025; qualified candidates with arrest or conviction records will be considered in compliance with laws.
Unique job features
The job features a 24/7 utilization management operation with flexible work schedules and opportunities to impact healthcare service quality and benefit utilization.
Company overview
CVS Health is a leading American healthcare company that operates a vast network of pharmacies and retail clinics. They generate revenue through prescription drug sales, over-the-counter medications, health services, and insurance products via their subsidiary, Aetna. Founded in 1963, CVS has grown significantly, acquiring Aetna in 2018 to expand into health insurance and integrating health services like MinuteClinic. Their mission focuses on improving patient health and access to care, making them a pivotal player in the healthcare industry.
How to land this job
Tailor your resume to highlight your clinical nursing experience, particularly your 2+ years in adult acute or critical care settings, and emphasize any utilization management or managed care exposure to align with CVS Health's requirements.
Showcase your proficiency in clinical assessment, care coordination, and applying clinical guidelines to support coverage determinations, as these are key responsibilities for this role.
Apply through multiple channels including the CVS Health corporate careers site and LinkedIn to maximize your application visibility and increase your chances of being noticed by recruiters.
Connect with professionals working in CVS Health's Utilization Management or Nursing divisions on LinkedIn; start conversations by referencing their recent projects, asking about the team culture, or expressing your enthusiasm for CVS Health’s commitment to transforming healthcare.
Optimize your resume for ATS by incorporating keywords from the job description such as 'clinical assessment,' 'utilization management,' 'care coordination,' 'RN licensure,' and 'managed care' to ensure it passes automated screenings effectively.
Consider using Jennie Johnson's Power Apply feature to automate tailored applications, identify multiple application portals, and find LinkedIn contacts to network with, allowing you to focus your time on preparing for interviews and enhancing your skills.
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