Hispanic Alliance for Career Enhancement
A1A UM Nurse Consultant
Hispanic Alliance for Career Enhancement, Los Angeles, California, United States
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.
Drives effective utilization‑management practices by ensuring appropriate and cost‑effective allocation of healthcare resources and facilitating appropriate healthcare services/benefits for members.
Conducts routine utilization reviews and assessments, applying evidence‑based criteria and clinical knowledge to evaluate the medical necessity and appropriateness of requested healthcare services.
Collaborates with healthcare providers, multidisciplinary teams, and payers to develop and implement care plans that optimize patient outcomes while considering the efficient use of healthcare resources.
Applies clinical expertise and knowledge of utilization‑management principles to influence stakeholders and networks of healthcare professionals by promoting effective utilization‑management strategies.
Reviews and analyzes medical records, treatment plans, and documentation to ensure compliance with guidelines, policies, and regulatory requirements پا subsequent recommendations for care coordination and resource optimization.
Consults with and provides expertise to other internal and external constituents throughout the coordination and administration of the utilization/benefit management function.
Communicates regularly with internal and external stakeholders to facilitate effective care coordination, address utilization‑management inquiries, and ensure optimal patient outcomes.
Provides IC‑related coaching and guidance to nursing staff and other healthcare professionals, sharing knowledge and expertise to enhance their understanding of utilization‑management principles and improve their clinical decision‑making.
Contributes to the development and implementation of utilization‑management strategies, policies, and procedures that aim to improve patient care quality, cost‑effectiveness, and overall healthcare system performance.
Education Bachelor’s degree preferred/specialized training/relevant professional qualification.
Registered Nurse (RN) required Registered Nurse (RN) required.
Prior Relevant Work Experience 3‑5 years.
Essential Qualifications
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 to choose the most appropriate option.
Ability to function in a clinical setting with diverse cultural dynamics of clinical staff and patients.
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical trabajadoresx pay range for this role is:
$26.01 - $68.55
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 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 航 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), 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 plenary, 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: 01/15/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
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.
Drives effective utilization‑management practices by ensuring appropriate and cost‑effective allocation of healthcare resources and facilitating appropriate healthcare services/benefits for members.
Conducts routine utilization reviews and assessments, applying evidence‑based criteria and clinical knowledge to evaluate the medical necessity and appropriateness of requested healthcare services.
Collaborates with healthcare providers, multidisciplinary teams, and payers to develop and implement care plans that optimize patient outcomes while considering the efficient use of healthcare resources.
Applies clinical expertise and knowledge of utilization‑management principles to influence stakeholders and networks of healthcare professionals by promoting effective utilization‑management strategies.
Reviews and analyzes medical records, treatment plans, and documentation to ensure compliance with guidelines, policies, and regulatory requirements پا subsequent recommendations for care coordination and resource optimization.
Consults with and provides expertise to other internal and external constituents throughout the coordination and administration of the utilization/benefit management function.
Communicates regularly with internal and external stakeholders to facilitate effective care coordination, address utilization‑management inquiries, and ensure optimal patient outcomes.
Provides IC‑related coaching and guidance to nursing staff and other healthcare professionals, sharing knowledge and expertise to enhance their understanding of utilization‑management principles and improve their clinical decision‑making.
Contributes to the development and implementation of utilization‑management strategies, policies, and procedures that aim to improve patient care quality, cost‑effectiveness, and overall healthcare system performance.
Education Bachelor’s degree preferred/specialized training/relevant professional qualification.
Registered Nurse (RN) required Registered Nurse (RN) required.
Prior Relevant Work Experience 3‑5 years.
Essential Qualifications
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 to choose the most appropriate option.
Ability to function in a clinical setting with diverse cultural dynamics of clinical staff and patients.
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical trabajadoresx pay range for this role is:
$26.01 - $68.55
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 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 航 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), 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 plenary, 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: 01/15/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr