UM Nurse
HumanaSalary not specified
Full Time
Mid-level (3 to 4 years)
$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, and preferred qualifications include Utilization Management experience, Managed Care Experience, and proficiency in grammar and syntax.
Responsibilities
The Utilization Management Nurse Consultant will support the coordination of medical services by composing and auditing approval, extension, and denial letters, while promoting quality effectiveness of healthcare services. They will maintain accurate documentation for risk management, regulatory, and accreditation requirements, and foster internal and external communication to enhance medical management services. As a team lead, they will assist the centralized letter team manager with daily meetings, documentation, investigations, template work, and ensuring effective communication, resource utilization, and continuous monitoring of centralized plans.
Skills
Registered Nurse
Utilization Management
Managed Care
Medical Services Coordination
Auditing
Letter Composition
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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