Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

🏈 Alabama, Connecticut, +25 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 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 appropriate clinical criteria, guidelines, policies, procedures and clinical judgment • Render coverage determinations or recommendations across the continuum of care • 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, effectiveness and benefit utilization • Consult and provide expertise to internal and external constituents in utilization and benefit management coordination and administration • Work a schedule that may include weekends, holidays and evening hours in a 24/7 utilization management operation • Work Monday, Tuesday, Thursday, Friday and Saturday from 8:00 AM to 5:00 PM EST with a one-hour lunch

🎯 Requirements

• 3+ years of experience as an RN • Active and unrestricted RN licensure in state of residence • Able to work in multiple IT platforms/systems • 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel) • Associates Degree in Nursing required • Prior authorization utilization experience preferred • Outpatient Clinical experience • Knowledge of Medicare/Medicaid • Managed care experience • UM Experience • 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 and private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide own workspace furniture • Ability to set up and use multiple monitors and navigate multiple applications simultaneously • Ability to use Microsoft Office 365 or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ 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.)