Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 2 minutes ago

🤠 Texas, Virginia – Remote

🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $29 - $62 / hour

⏱ Part 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 clinical 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, or programs • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with and provide expertise to internal and external constituents regarding utilization and benefit management • Work in a typical office environment with productivity and quality expectations • Perform close inspection of handwritten and computer-generated documents and PC monitors • Sit for extended periods, talk on the telephone, and type on a computer • Multitask, prioritize, and adapt effectively to a fast-paced, changing environment

🎯 Requirements

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Active, current, and unrestricted RN licensure in the state of residence • Must reside in EST or CST • Associates Degree required • Proficiency with computer skills, including navigating multiple systems and keyboarding • Ability to use multiple monitors and applications simultaneously • Ability to communicate via 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 manage strong passwords and recognize suspicious emails or links • Ability to resolve common technical issues independently • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 50 Mbps download and 5 Mbps upload • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Ability to work weekends, holidays, and evening hours in a 24/7 operation • BSN preferred • Managed Care experience preferred, especially Utilization Management

🏖️ Benefits

• Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Dental benefits • Vision benefits • Wellness resources • Employee discounts • Access to certain voluntary benefits • Other programs supporting colleagues’ physical, emotional, and financial well-being