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 and assess clinical information to make coverage and care recommendations • Apply clinical guidelines, policies, and nursing judgment across the continuum of care • Collaborate with providers and care teams to support treatment plans • Identify opportunities for care management programs and service integration • Promote quality outcomes and effective healthcare utilization • Serve as a clinical resource for internal and external stakeholders • Work schedules that may include evenings, weekends, and holidays in a 24/7 operation • Navigate multiple monitors and applications to streamline tasks and improve efficiency • Communicate through email, calendar invites, Teams messaging, and virtual meetings • Log in to secure systems, manage passwords, and recognize suspicious emails or links • Resolve common technical issues and contact IT when needed

🎯 Requirements

• Active, unrestricted RN license in state of residence • 2+ years of RN experience in adult acute care or critical care • Associate's degree in Nursing • Strong computer, communication, and multitasking skills • Ability to work in a fast-paced environment • Preferred: 2+ years of Med-Surg or specialty clinical experience • Preferred: Utilization Management and/or Managed Care experience • Preferred: BSN • Preferred: Residence in the Eastern Time Zone • 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 • Ability to work within the state and city of confirmed residence • Comfort setting up and using multiple monitors and navigating multiple applications • 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 access secure systems such as VPN and EHR portals • Ability to lock computer screens, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills as the workplace evolves • Must provide own workspace furniture

🏖️ 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