Utilization Management Nurse Consultant

Job not on LinkedIn

🕒 4 days ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review clinical information and apply evidence-based criteria to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care • Collaborate with providers and care teams to facilitate appropriate treatment plans • Identify opportunities to improve quality, efficiency, and healthcare utilization • Connect members to additional programs and services as appropriate • Serve as a clinical resource for internal and external stakeholders

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of adult acute care and/or critical care nursing experience • Strong clinical assessment and decision-making skills • Ability to navigate multiple computer systems and manage competing priorities • Excellent verbal and written communication skills • Associate Degree in Nursing required • 2+ years of Med-Surg or specialty nursing experience preferred • Managed Care experience, particularly Utilization Management preferred • Reside in the Eastern Time Zone preferred • BSN preferred

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families