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CVS Health UM Nurse Consultant in Florida

Job Description

This is a Telework role but candidate must reside in or near Hillsborough, Manatee, Polk, Highland, Hardee Counties and surrounding areas and be able to travel to facilities within these counties. Hours required are M - F 8am - 5 pm EST with some flexibility for start/ stop times.Local travel up to 50%.Applies critical thinking, evidence-based clinical criteria to support contractual rebalancing goals:• Complete at least 10 NF member assessments weekly• Rebalance a minimum of 5 members a month or clearly document why goal was not met.• Support the Health Plan Rebalancing Initiative goal of successful transitions: Assess, identify, screen and transition NH members into the community• Follow up on CM referrals and visit current NH members in-person at least twice a week to complete the rebalancing events and screening assessments.• Complete telephonic or in-person contact to assess the home prior to discharge and identify any environmental supports needed to support transition (i.e. ramp, DME installation etc.). Conduct an in-person Significant Change Visit with member and Rep if applicable, within 5 days of transition. Coordinate provision of services as needed, establish Plan of Care, and document all actions taken.• Visit members in rehab settings during first few days of rehab to smooth transition home; coordinate services; suggest alternatives to Custodial SNF placement and collaborate with existing CM staff for a smooth transition home.Follow members identified as inpatient in hospitals throughout the subsequent care continuum until the member is able to return to prior level of functioning in the community• Contact facility’s Business Office once a week to follow-up on member’s census and will coordinate with Social Services and CM to facilitate discharge.• Work collaboratively with case managers to identify high risk community members and implement appropriate interventions to prevent lapse or coordinate safe transition (Upon receiving referral)• Drive enhanced value of health care to increase member satisfaction and retention, and drive new membership growth.• Be involved in at least two community relations event per year• Engage in building strong relationships that contribute towards member satisfaction and retention.

Pay Range

The typical pay range for this role is:

Minimum: 28.25

Maximum: 60.50

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


Required Qualifications

-Active, unrestricted and good standing RN license in the state of Florida.-Candidate must reside in FL and area of coverage.- Minimum 2 years of clinical experience-Willing and able to travel 50% of their time to meet members face to face in Hillsborough, Manatee, Polk, Highland, Hardee Counties and surrounding areas.

Preferred Qualifications

-Managed Care experience-Discharge coordination experience-Transition of care experience-Home Health experience- Case Management experience- Position requires proficiency with computer skills which includes navigating multiple systems- Ability to work in a fast-paced environment


Associate Degree Required, BSN preferred.

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.