Utilization Management Nurse Consultant

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🔥 40 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. • Communicates with providers and other parties to facilitate care/treatment. • Identifies members for referral opportunities to integrate with other products, services and/or programs. • Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

🎯 Requirements

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Must have active current and unrestricted RN licensure in state of residence • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours • 2+ years of clinical experience required in med surg or specialty area • Managed Care experience preferred, especially Utilization Management • Preference for those residing in EST zones

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • bonus eligibility