Hispanic Alliance for Career Enhancement
Utilization Management Nurse Consultant
Hispanic Alliance for Career Enhancement, Washington, District of Columbia, us, 20022
Position Summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Responsibilities
Utilizes 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.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment
Identifies members for referral opportunities to integrate with other products, services and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Typical office working environment with productivity and quality expectations.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written
Required Qualifications
2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
Must have active current and unrestricted RN licensure in state of residence.
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Preferred Qualifications
2+ years of clinical experience required in med surg or specialty area.
Managed Care experience preferred, especially Utilization Management.
Preference for those residing in EST zones.
Education
Associates Degree required
BSN preferred
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 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.
Great benefits for great people
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and 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 resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 09/10/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Responsibilities
Utilizes 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.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment
Identifies members for referral opportunities to integrate with other products, services and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Typical office working environment with productivity and quality expectations.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written
Required Qualifications
2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
Must have active current and unrestricted RN licensure in state of residence.
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Preferred Qualifications
2+ years of clinical experience required in med surg or specialty area.
Managed Care experience preferred, especially Utilization Management.
Preference for those residing in EST zones.
Education
Associates Degree required
BSN preferred
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 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.
Great benefits for great people
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and 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 resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 09/10/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr