Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 15 hours ago

🏄 California, Nevada, +3 more states – Remote

🏄 California – Remote 🎰 Nevada – Remote 🌲 Oregon – Remote ⛷️ Utah – 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 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, and 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 24/7 utilization management operation with weekend, holiday, and evening schedules • Perform computer-based document inspection, telephone communication, typing, multitasking, and navigation of multiple systems

🎯 Requirements

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Active, current, and unrestricted RN licensure in the state of residence • Availability for weekends, holidays, and evening hours, including approximately 12 weekend days/year, 2–3 late shifts, and 1 major and 1 minor holiday/year • Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously • Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently and contact IT for unresolved issues • Openness to learning new skills as the workplace evolves • 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; WiFi and satellite internet are not permitted • Quiet, secure, private, and designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide workspace furniture, such as a desk or standing desk • Must obtain required internet speeds and comply with Work From Home requirements if hired • Associate degree required • Managed Care experience preferred, especially Utilization Management • 2+ years of clinical experience in med surg or a specialty area preferred • Preference for candidates residing in PST 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, including keyboard, monitor, computer, and headset

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