Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 3 minutes ago

🌵 Arizona, California, +4 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote 🥔 Idaho – Remote 🎰 Nevada – Remote 🌲 Oregon – Remote ☕ Washington – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 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 judgment to render coverage determinations or recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services and programs • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with internal and external constituents on utilization and benefit management • Work within a 24/7 operation including weekends, holidays and evening hours • Meet productivity and quality expectations in a typical office working environment • Perform close inspection of handwritten and computer-generated documents and PC monitors • Sit for extended periods, talk on the telephone, type and multitask

🎯 Requirements

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Active, current and unrestricted RN licensure in state of residence • 2+ years of clinical experience in med surg or specialty area • Managed Care experience preferred, especially Utilization Management • Preference for candidates residing in PST zones • Associate Degree required • BSN preferred • Direct/hardwired internet connection to a modem/router within 7 feet of computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure and private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Proficiency with computer skills, multiple systems and keyboarding • Effective verbal and written communication skills • Ability to work weekends, holidays and evening hours • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to use secure systems such as VPN and EHR portals • Ability to troubleshoot common technical issues and follow security practices

🏖️ 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 (keyboard, monitor, computer, headset, etc.) • Remote work from home