Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 17 hours ago

🐎 Kentucky, New Jersey, +3 more states – Remote

🐎 Kentucky – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🔔 Pennsylvania – Remote

💵 $29 - $62 / 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 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 and provide expertise to internal and external constituents regarding utilization and benefit management • Work in a 24/7 operation with weekends, holidays and evening hours • Perform work in a typical office working environment with productivity and quality expectations • Inspect 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 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 state of residence • Associates Degree required • BSN preferred • Managed Care experience preferred, especially Utilization Management • Preference for those residing in EST zones • 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 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer and information security practices • Ability to troubleshoot common technical issues independently • Direct/hardwired internet connection within 7 feet of modem/router • Minimum internet speed of 50 Mbps download and 5 Mbps upload • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Must provide own workspace furniture • Must be able to work weekends, holidays, and evening hours

🏖️ 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.)

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