Utilization Management Nurse Consultant

May 14

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CVS Health

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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.

Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

•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

🎯 Requirements

•2+ years of experience as a Registered Nurse in adult acute care/critical care setting •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.

🏖️ Benefits

•Affordable medical plan options •401(k) plan (including matching company contributions) •Employee stock purchase plan •No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs •Confidential counseling and financial coaching •Paid time off •Flexible work schedules •Family leave •Dependent care resources •Colleague assistance programs •Tuition assistance •Retiree medical access •Many other benefits depending on eligibility