Utilization Management Nurse Consultant

Texas Twp, Michigan, United States

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$60,528 – $129,644Compensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Pharmacy, Health InsuranceIndustries

Requirements

Candidates must have at least 1 year of experience as a Registered Nurse with an unrestricted license in their state of residence and at least 1 year of clinical experience. An Associate's or Bachelor's degree is required. Utilization management and managed care experience, along with proficiency in grammar and syntax and the ability to multi-task, are preferred qualifications.

Responsibilities

The Utilization Management Nurse Consultant will support the coordination of medical services by composing and auditing approval, extension, and denial letters. They will promote quality and effectiveness of healthcare services, maintain accurate documentation for risk management and regulatory compliance, and foster internal and external communication. The team lead will also assist with daily meetings, documentation, investigations, template work, and ensuring effective communication and resource utilization for the centralized letter team.

Skills

Registered Nurse

Utilization Management

Managed Care

Medical Services Coordination

Auditing

Documentation

Risk Management

Regulatory Compliance

Accreditation

Communication

Grammar

Syntax

Multi-tasking

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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