UM Nurse Consultant – Rhode Island

Remote @CVS Health posted 4 weeks ago

Job Description

Works within a small team of Utilization management Subject Matter Experts
Works with SWAT leadership and Health Plan Leadership to address any urgent and/or critical needs of the health plan
Conduct strategic analysis of current data to devise tactical deployment to have a positive impact on the health plans
Fast paced environment
Adaptability is essential
Work collaboratively with areas beyond UM when necessary
Evaluate and implement processes or responses that fall outside of the normal operating procedures, without jeopardizing contractual or regulatory requirements

Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
Active RN License

2+ years of Medicaid Experience
3+ years of Utilization Management Experience

Preferred Qualifications
Experience in multiple areas of UM such as INPT and OP
Claims knowledge/experience

Education
Bachelor’s degree required

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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