Utilization Management Nurse Consultant

Argentina

Apply with AI Apply

Not SpecifiedCompensation

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

Full TimeJob Type

UnknownVisa

Healthcare, Pharmaceuticals, RetailIndustries

Requirements

Candidates must have at least 2 years of experience as a Registered Nurse in an adult acute care or critical care setting and possess an active, current, and unrestricted RN license in their state of residence. An Associate's Degree is required, with a BSN preferred. Experience in utilization management or managed care is preferred, particularly for those residing in CT zones.

Responsibilities

The Utilization Management Nurse Consultant will utilize clinical experience to assess, plan, implement, coordinate, and evaluate healthcare services for members. This involves gathering clinical information, applying appropriate criteria and guidelines to make coverage determinations, and communicating with providers. The role also includes identifying members for referral opportunities, promoting quality and effectiveness of healthcare services, and consulting with internal and external constituents. This is a 24/7 operation requiring flexible work schedules, including weekends, holidays, and evening hours.

Skills

Utilization Management

Clinical Assessment

Care Coordination

Healthcare Services

Benefit Utilization

Clinical Judgment

Communication

Problem-Solving

Multitasking

Prioritization

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.

Land your dream remote job 3x faster with AI

Try Jobo Free