Utilization Management Nurse Consultant (Weekends - CST)

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.Position SummaryHours of operation/Work schedule Friday/Saturday/Sunday/Monday 10 hour shifts. First 6 months of training will be M-F 8-5 CST. • 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. Required Qualifications • Registered Nurse in state of residence. • 3+ years of Nursing experience. Preferred Qualifications • Prior authorization utilization management/review experience preferred Outpatient Clinical experience. • Knowledge of Medicare/Medicaid Managed care experience Education • Associates Degree in Nursing • BSN preferred