Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – 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

• Coordinate, document and communicate all aspects of the utilization/benefit management program and plan sponsors • Ensure members receive appropriate care at the appropriate time and location using designated criteria • Review written and electronic clinical records • Review services to assure medical necessity • Apply clinical expertise to assure appropriate benefit utilization • Facilitate safe and efficient discharge planning • Work closely with facilities and providers to meet complex member needs • Adhere to federal and state regulated turnaround times

🎯 Requirements

• Must have active current and unrestricted RN license in state of residence • Minimum of 3 years of acute hospital clinical experience as an RN • Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time • A private designated workspace free of distractions and high-speed internet • Must be willing and able to work Monday-Friday 8am-5pm EST with occasional weekend on-call and holiday rotation • Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues • Experience with Microsoft Office including PowerPoint, Excel, and Word • Strong telephonic communication skills • 1+ years of Utilization Review experience • 1+ years of Managed Care experience • Associate’s Degree required • BSN preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay