Utilization Management Nurse Consultant - Prior Authorizations

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.

This role is Telework anywhere for prior authorization

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring recertification. Being a member advocate as well as using assessment skills to assure member needs are being met. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Sedentary work involves periods of sitting, talking, listening and computer use