Utilization Management, Nurse Consultant

Job not on LinkedIn

🔥 46 minutes ago

🏖️ New Jersey, New York, +3 more states – Remote

🏖️ New Jersey – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🔔 Pennsylvania – Remote ⛰️ West Virginia – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

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• Jobs at this company usually fill in 21 days.

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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, and programs • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization • Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work in a 24/7 operation with weekends, holidays, and evening hours • Perform close inspection of handwritten and computer-generated documents and PC monitors • Sit for extended periods, talk on the telephone, and type on the computer • Multitask, prioritize, and adapt to a fast-paced changing environment

🎯 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 • Ability to work weekends, holidays, and evening hours • Ability to set up and use multiple monitors and navigate multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace) • 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 work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Associates Degree required • Managed Care experience preferred, especially Utilization Management • 2+ years of clinical experience in med surg or specialty area • Preference for candidates residing in Eastern zones

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • 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.)

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