Nurse Consultant

Job not on LinkedIn

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

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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

• Coordinate, document, and communicate all aspects of the utilization/benefit management program • Drive effective utilization management practices and ensure appropriate, cost-effective allocation of healthcare resources • Conduct routine utilization reviews and assessments using evidence-based criteria and clinical knowledge • Evaluate medical necessity and appropriateness of requested healthcare services • Collaborate with healthcare providers, multidisciplinary teams, and payers to develop and implement care plans • Review and analyze medical records, treatment plans, and documentation for compliance with guidelines, policies, and regulations • Provide recommendations for care coordination and resource optimization • Communicate with internal and external stakeholders to facilitate care coordination and address utilization management inquiries • Provide coaching and guidance to nursing staff and healthcare professionals • Develop and implement utilization management strategies, policies, and procedures • Facilitate safe and efficient discharge planning • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations or recommendations • Identify referral opportunities and opportunities to improve healthcare quality and benefit utilization

🎯 Requirements

• RN with active and unrestricted state licensure in their state of residence • 2+ years of acute hospital clinical experience as an RN • Preference for medical-surgical and ICU experience • Applicants whose only acute care experience is in behavioral health are not accepted • Working knowledge of problem solving and decision making skills • Working knowledge of medical terminology • Working knowledge of digital literacy skills • Ability to deal tactfully with customers and community • Ability to handle sensitive information ethically and responsibly • Ability to consider relative costs and benefits of potential actions • Ability to function in clinical settings with diverse cultural dynamics • Associate Degree in Nursing is minimum required; BSN preferred • Preferred: 1+ years’ Utilization Review experience • Preferred: 1+ years’ Managed Care experience • Strong telephonic communication skills • Preferred: 1+ years’ experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook) • Experience using a computer while toggling between screens, keyboarding, and speaking to customers • Independent and sound judgment and strong decision-making skills • Well-developed interpersonal skills • Ability to manage multiple priorities and effective organizational and time management skills • Ability to use a computer station and sit for extended periods of time

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility