[Remote] UM Nurse Consultant at CVS Health

United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Registered Nurse with active, current, and unrestricted RN licensure in state of residence
1+ years of Managed Care Experience; and experience with utilization review (Preferred)
1+ years of clinical experience in acute or post-acute setting (Preferred)
Diploma RN acceptable; Associate degree/BSN preferred
Proficiency with computer skills, including navigating multiple systems and keyboarding
Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment
Ability to sit for extended periods, talk on the telephone, and type on the computer

Responsibilities

Utilize clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members
Gather clinical information and apply appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicate with providers and other parties to facilitate care/treatment
Identify members for referral opportunities to integrate with other products, services, and/or benefit programs
Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Meet set productivity and quality expectations
Maintain availability by phone, videoconference, and email during work hours
Be available to come into the office or client location for work-related meetings, training sessions, or other events as directed by their Leader

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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