Utilization Management Nurse Consultant

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⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program • ensure the member is receiving the appropriate care, at the appropriate time, and at the appropriate 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 needs of the member

🎯 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.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility