Utilization Management Nurse Consultant

Job not on LinkedIn

🕒 2 days ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members. • Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care. • Communicate with providers and other parties to facilitate care and treatment. • Identify members for referral opportunities to integrate with other products, services, or benefit programs. • Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization. • Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. • Meet set productivity and quality expectations as established by UMNC.

🎯 Requirements

• Registered Nurse • Diploma RN acceptable; Associate degree / BSN preferred • 3+ years of experience as a Registered Nurse • 1+ years of clinical experience in acute or post-acute setting • 1+ years of Utilization Management / Care Management Experience • active current and unrestricted RN licensure in state of residence • Preferred Qualifications - Utilization Management experience preferred

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility