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 guidelines to make coverage recommendations and determinations • Collaborate with providers and healthcare teams to facilitate appropriate care and treatment • Identify opportunities for care management, quality improvement, and member support programs • Provide clinical expertise to internal and external partners on utilization and benefit management activities • Navigate multiple systems while managing a fast-paced, highly collaborative workload • Review cases, evaluate medical necessity, coordinate care, and support members in accessing appropriate healthcare services and benefits

🎯 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 required • Strong communication, organizational, and multitasking skills • Ability to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation • 2+ years of Med Surg or other specialty clinical experience preferred • Utilization Management and/or Managed Care experience preferred • BSN preferred • Eastern Time Zone residency preferred • Ability to obtain a 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 • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • 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 tools • Ability to log in to secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize 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, and headset • Remote work from home