[Remote] Utilization Management Nurse Consultant at CVS Health

Georgia, Vermont, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

2+ years of experience as a Registered Nurse in adult acute care/critical care setting
Active current and unrestricted RN licensure in state of residence
Associates Degree required (BSN preferred)
Proficiency with computer skills, including navigating multiple systems and keyboarding
Effective communication skills, both verbal and written
Ability to multitask, prioritize, and adapt to a fast-paced changing environment
Availability for 24/7 operation including weekends, holidays, and evening hours

Responsibilities

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members
Gathers clinical information and applies appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment
Identifies members for referral opportunities to integrate with other products, services, and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Skills

Key technologies and capabilities for this role

Utilization ManagementClinical AssessmentCare CoordinationClinical CriteriaCoverage DeterminationHealthcare ServicesBenefit ManagementMultitaskingProvider Communication

Questions & Answers

Common questions about this position

What is the pay range for this Utilization Management Nurse Consultant role?

The typical pay range for this role is $26.01 - $56.14 per hour.

Is this a remote position, or is there an office requirement?

This information is not specified in the job description.

What are the required qualifications for this nurse consultant position?

Candidates must have 2+ years of experience as a Registered Nurse in adult acute care/critical care setting and an active current unrestricted RN licensure in the state of residence.

What is the work schedule like for this role?

Utilization Management is a 24/7 operation, so work schedules will include weekends, holidays, and evening hours in a typical office environment.

What makes a strong candidate for this position?

Strong candidates will have an Associates Degree (BSN preferred), 2+ years in med surg or specialty areas, managed care or Utilization Management experience, and reside in EST/CST zones.

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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