Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 16 hours ago

🌪️ Kansas – Remote

🌪️ Kansas – Remote

💵 $26 - $56 / 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

• Review and assess clinical information to support coverage determinations and care coordination • Apply clinical guidelines, policies, and professional judgment to utilization management decisions • Collaborate with providers and interdisciplinary teams to facilitate appropriate treatment and services • Identify opportunities for care management referrals and member support programs • Promote quality, cost-effective healthcare delivery and benefit utilization • Provide utilization management expertise and support to internal and external stakeholders • Work within a remote office environment with productivity and quality performance expectations • Work schedules that may include evenings, weekends, and holidays in a 24/7 operation

🎯 Requirements

• Active, unrestricted RN license in your state of residence • Minimum 2 years of RN experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • Strong communication, multitasking, and computer skills • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure and private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Own workspace furniture, such as a desk or standing desk • Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently and contact IT for unresolved issues • Openness to learning new skills as the workplace evolves

🏖️ 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 • Company-provided equipment including keyboard, monitor, computer, headset, etc.