Utilization Management Nurse Consultant
CVS Health
- Rutherford, New Jersey, United States
- Rutherford, New Jersey, United States
About
Review and assess clinical information using established guidelines and criteria
Make coverage determinations across the continuum of care
Collaborate with providers and internal partners to coordinate care
Identify opportunities to improve care quality and utilization outcomes
Refer members to programs and services that support better health outcomes
Serve as a clinical resource for internal and external stakeholders
Required Qualifications
Active, unrestricted RN license in state of residence
3+ years of RN experience
1+ year of Med/Surg experience
Proficiency with Microsoft Office (Outlook, Teams, Excel)
Associate's degree in nursing (BSN preferred)
Preferred Qualifications
Utilization Management or Prior Authorization experience
Managed care and/or Medicare experience
Experience with MedCompass
Ambulatory surgery experience
This is a great opportunity for an RN looking to leverage clinical expertise in a collaborative, non-bedside role that impacts patient care at scale. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical 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. 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 that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) . We anticipate the application window for this opening will close on: 05/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.
Languages
- English
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