Hybrid Nurse Consultant

at CVS Health

• Job title: Nurse Consultant
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $29 - $62 per hour
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, United States

About the role

• Precertification Nurse Case Manager at CVS Health reviewing medical records and coordinating care for members. Communicating with providers and members to ensure medical necessity for procedures.

Responsibilities

• Responsible for reviewing medical records to determine the medical necessity for elective procedures.
• Communicate the current status and determinations to providers and members.
• Guide members through the health care system, assess conditions, and coordinate care.
• Evaluate benefit plan eligibility and facilitate integrative functions to Aetna programs.
• Conduct routine utilization reviews and assessments using evidence-based criteria.
• Collaborate with healthcare providers to develop care plans that optimize patient outcomes.

Requirements

• Must have active, current and unrestricted compact RN state licensure
• Must reside within 45 miles to office locations in New Albany OH, Chandler AZ or High Point NC
• 3+ years of clinical practice experience required
• Must be able to work Monday through Friday 8:00 AM to 4:30 PM, EST with evening rotation required about 2 times a month until 8pm, EST.
• 2+ years of experience using Microsoft Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• 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 resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.