Utilization Management Nurse Consultant Job at Hispanic Alliance for Career Enhancement, Washington DC

V1ovSW0xVE5iSk5uQ0hvdkM3LzAwUzlFK1E9PQ==
  • Hispanic Alliance for Career Enhancement
  • Washington DC

Job Description

Position Summary

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

Responsibilities


  • 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.
  • Typical office working environment with productivity and quality expectations.
  • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
  • Sedentary work involving periods of sitting, talking, listening.
  • Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
  • Effective communication skills, both verbal and written


Required Qualifications
  • 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
  • Must have active current and unrestricted RN licensure in state of residence.
  • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.


Preferred Qualifications
  • 2+ years of clinical experience required in med surg or specialty area.
  • Managed Care experience preferred, especially Utilization Management.
  • Preference for those residing in EST zones.


Education
  • Associates Degree required
  • BSN preferred


Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $26.01 - $74.78
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.

Great benefits for great people
  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.


For more information, visit

We anticipate the application window for this opening will close on: 09/10/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

#J-18808-Ljbffr

Job Tags

Hourly pay, Full time, Temporary work, Work at office, Local area, Flexible hours, Afternoon shift,

Similar Jobs

e-Adult Shop

Sales Associate Retail Job at e-Adult Shop

 ...brighten everyone's day that walks through our doors. We pride ourselves on having a sex-positive and body-positive culture in our stores and on our ability to help those from all walks of life. Who we are looking for: A results-driven salesperson. THIS IS A SALES... 

Compass Group

FOOD TRANSPORTER/DELIVERY DRIVER (FULL TIME) Job at Compass Group

 ...Food Transporter/Delivery Driver We are hiring immediately for full time FOOD TRANSPORTER/DELIVERY DRIVER positions. Location: Los Alamos HS - Los Alamos, NM 87544 Note: online applications accepted only. Schedule: Full time schedule; Monday - Friday. Hours may... 

The Planet Group

Environmental Waste Project Manager Job at The Planet Group

 ...Job Description Title: Environmental Waste Project Manager Starting Pay: Up to 75k depending on experience Location: Kokomo IN Direct Hire 1st shift role 8:00am-4:30pm (Flexible, can start at 7am) Must Haves: o Looking for an person 2+ years of experience... 

Drury Hotels

Laundry Attendant Job at Drury Hotels

 ...Award-winning: Ranked among Newsweek's America's Greatest Workplaces 2025 Basic Function & Job Duties: Performs a variety of laundry duties to provide clean and sanitary linens and terry for our guests including but not limited to washing, drying, sorting, folding... 

Pursuit Collection

Banquet Server Job at Pursuit Collection

 ...Be a utility player who can complete a variety of job duties This job description describes at a high level what a Banquet Server does, but no document can anticipate every single task, issue or project that could come up. We work as a team and believe that we...