CVS Health

Utilization Management Nurse Consultant

Texas Twp, Michigan, United States

Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Pharmaceuticals, Retail PharmacyIndustries

Requirements

Candidates must have at least 2 years of experience as a Registered Nurse in an adult acute care or critical care setting. A current and unrestricted RN license in the state of residence is required. An Associate's Degree is required, with a BSN preferred. Experience in medical-surgical or a specialty area, as well as managed care or utilization management experience, is preferred. The role requires proficiency in computer skills, including navigating multiple systems and keyboarding, along with effective verbal and written communication skills. Work schedules will include weekends, holidays, and evening hours as Utilization Management is a 24/7 operation.

Responsibilities

The Utilization Management Nurse Consultant will utilize clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate options for healthcare services and benefits. This includes gathering clinical information, applying clinical criteria and guidelines, and rendering coverage determinations. Responsibilities also involve communicating with providers, identifying members for referral opportunities, promoting quality and effectiveness of healthcare services, and consulting with internal and external constituents to administer the utilization/benefit management function.

Skills

Clinical Assessment
Care Planning
Healthcare Services Coordination
Benefit Utilization
Clinical Criteria Application
Provider Communication
Multitasking
Prioritization
Adaptability
Fast-paced Environment Adaptation

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