Utilization Management Nurse Consultant

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🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 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

• Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services, or benefit programs • Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization • Consult and provide expertise to internal and external constituents in coordinating and administering utilization/benefit management • Meet productivity and quality expectations established by UMNC • Work a weekend alternative schedule with coverage on both Saturday and Sunday • Attend occasional on-site meetings, training sessions, or other events at an office or client location when directed

🎯 Requirements

• Registered Nurse • Diploma RN acceptable • 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 • May be required to obtain additional Nursing Licenses as business needs require • Effective verbal and written communication skills • Proficiency with computer skills, including navigating multiple systems and keyboarding • Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment • Capacity to sit for extended periods, talk on the telephone, and type on the computer • Coverage of both Saturday and Sunday each week • Availability by phone, videoconference, and email during work hours

🏖️ Benefits

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

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