No nights and no on call!

Weekend/Holiday rotation 2-4 days monthly.

Hours of operation/Work schedule: Monday-Friday 8am- 5:30 pm Central Standard Time. Weekend/Holiday Rotation

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.

For more information on our benefit programs, please visit
https://jobs.cvshealth.com/employee-benefits

Required Qualifications

- 3+ years of experience as an RN (MED-SURG, ER, ICU)

- 1+ years of inpatient hospital experience

- Must have active current and unrestricted RN licensure in state of residence

- Must have previous inpatient utilization review experience

- Able to work in multiple IT platforms/system

- Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties.

Preferred Qualifications

- Knowledge of Medicare/Medicaid

- Managed care (MCO) experience

- UM, and Concurrent review experience

- UM/CM/MCG Certification

- Med Compass experience

Education

Associates Degree in Nursing; BSN preferred

Pay Range

The typical pay range for this role is:

$29.50 - $63.75

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/11/2024