Utilization Management Nurse Consultant

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🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

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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 clinical information and apply evidence-based criteria to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care • Collaborate with providers and care teams to facilitate appropriate treatment plans • Identify opportunities to improve quality, efficiency, and healthcare utilization • Connect members to additional programs and services as appropriate • Serve as a clinical resource for internal and external stakeholders • Work afternoon/evening shifts as part of 24/7 operations • Work approximately 40 hours per week • Navigate multiple monitors, applications, secure systems, and communication tools to perform work efficiently

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of adult acute care and/or critical care nursing experience • Strong clinical assessment and decision-making skills • Ability to navigate multiple computer systems and manage competing priorities • Excellent verbal and written communication skills • Associate Degree in Nursing required • Willingness to work weekends, holidays, and evening shifts • Direct/hardwired internet connection to a modem/router within 7 feet of the computer, or ability to obtain one • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines • Ability to set up and use multiple monitors and navigate multiple applications simultaneously • Ability to communicate through 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 lock computer screens when unattended, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently and contact IT when needed • Openness to learning new skills as the workplace evolves • Preferred: 2+ years of Med-Surg or specialty nursing experience • Preferred: Managed Care experience, particularly Utilization Management • Preferred: BSN • Preferred: Residence in the Eastern Time Zone

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting colleagues’ physical, emotional, and financial well-being • Company-provided equipment including keyboard, monitor, computer, and headset • Remote work from home • Comprehensive benefits package for full-time colleagues and their families