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Utilization Management Nurse Consultant

Company: CVS Health
Location: High Point
Posted on: June 6, 2021

Job Description:

Job Description

This role will be based in the High Point, NC office once COVID restrictions are lifted.

Internal employees may remain working from home.

Required hours are M-F 8:30am-5pm EST with rotation until 9pm EST 2-3 times per month.

Are you tired of bedside nursing?

Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?


As a Utilization Nurse Consultant you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Looking for someone who enjoys working in an office in a high energy and motivated team environment and is detail oriented and highly organized.

This role is located in the High Point, NC office and will require being in the office at least the first 12-18 months. Work from home opportunities may be available after 12-18 months of employment, determined by business need.

This is a dynamic and passionate team, with much support! This is ideal for an applicant seeking a fast paced environment.

To service west coast customers, nurses will be required to work 2-3 times a month until 9:00pm EST after training. Saturday work required after 6 months of training as needed to meet business needs.

The office is located at 4050 Piedmont Parkway, High Point, NC"

Required Qualifications

  • Active, unrestricted RN License required
  • 2+ years of clinical experience required (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more!)
  • Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills required.
  • Ability to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skills required.
  • Ability to manage multiple priorities, effective organizational and time management skills required.
  • This position is in an office environment using a computer station and may require sitting for extended periods of time.

Preferred Qualifications

  • Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
  • Any Managed Care background is a plus.
  • Utilization Review experience preferred, but not required.


BSN, or Associates Degree with equivalent experience

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.

Keywords: CVS Health, High Point , Utilization Management Nurse Consultant, Other , High Point, North Carolina

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