PRN Utilization Review Nurse Reviewer
Blank StreetSalary not specified
Full Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
[Remote] Utilization Management Nurse Consultant - Work From Home at CVS Health
Georgia, Vermont, United States
Not SpecifiedCompensation
Mid-level (3 to 4 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
- Ability to multitask, prioritize, and adapt to a fast-paced changing environment
- Effective communication skills, both verbal and written
- 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 the 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
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, and are there any location preferences?
This is a work-from-home position. Preference is given to those residing in EST/CST zones.
What are the required qualifications and skills for this role?
Candidates need 2+ years of experience as a Registered Nurse in adult acute care/critical care, active current and unrestricted RN licensure in state of residence, proficiency with computer skills including navigating multiple systems and keyboarding, and effective verbal and written communication skills.
What is the work schedule like for this position?
Utilization Management is a 24/7 operation, so work schedules will include weekends, holidays, and evening hours. It is a full-time role with anticipated weekly hours of 40.
What education is required or preferred for this role?
An Associates Degree is required, with a BSN preferred. Additional preferred qualifications include 2+ years of clinical experience in med surg or specialty area and managed care experience, especially in Utilization Management.
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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