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Position Summary

100% remote position from anywhere in the U.S.

Work hours: 11:30am-8:00pm EST, Monday-Friday.

100% attendance is required during the first 3 weeks of training / 8:30am-5pm EST, Monday-Friday.

Work in clinical telephone queue working with providers to secure additional information for prior authorization review.

Weekend/holiday coverage will occasionally be required.

This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

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 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 1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization.

5 years of a variety clinical experience required including acute care, home health, or long-term care.

5 years demonstrated ability to make thorough, independent decisions using clinical judgement.

A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all noncompact states.

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. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service. Preferred Qualifications 1+ years Managed Care (MCO) preferred.

1+ years demonstrated experience working in a high-volume clinical call center environment.

Remote work experience. Education

Associate degree in nursing RN required.

BSN preferred.

Pay Range

The typical pay range for this role is:

$26.01 - $62.31

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: 04/22/2024