Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 3 minutes ago

🏈 Alabama, Connecticut, +16 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🧀 Wisconsin – Remote

💵 $26 - $56 / 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 healthcare service and benefit options 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 and provide expertise to internal and external constituents in utilization and benefit management coordination and administration • Work in a typical office environment with productivity and quality expectations • Perform close inspection of handwritten and computer-generated documents and PC monitor content • Sit for extended periods, talk on the telephone, and type on a computer • Multitask, prioritize, and adapt to a fast-paced changing environment

🎯 Requirements

• Active and unrestricted Registered Nurse (RN) license in the candidate’s state of residence • 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Availability to work weekends, holidays, and evening hours as required • Associates Degree in Nursing (REQUIRED) • 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 • WiFi and satellite internet are not permitted • Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Ability to navigate multiple systems and applications simultaneously • Ability to use digital communication channels including email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer and password security practices and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Bachelors Degree in Nursing (PREFERRED) • 2+ years of clinical experience in med surg or specialty area • Managed care or Utilization Management experience preferred • Preference for candidates residing in EST zones

🏖️ 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 a designated home workspace