Utilization Management Nurse Consultant - Work at Home - Eastern Standard Time Zone

CVS Health-posted 3 months ago
$32 - $68/Yr
Full-time
Allentown, PA
5,001-10,000 employees
Ambulatory Health Care Services
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At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

  • 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.
  • Typical office working environment with productivity and quality expectations.
  • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
  • Sedentary work involving periods of sitting, talking, listening.
  • Work requires sitting for extended periods, talking on the telephone and typing on the computer.
  • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
  • Effective communication skills, both verbal and written.
  • Preference to residents in EST Zone.
  • 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
  • Must have active current and unrestricted RN licensure in state of residence.
  • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
  • Typical work schedule is Mon-Fri 9-5 In your time zone.
  • Holiday, Weekend and 7PM shift on rotation with team.
  • 2+ years of clinical experience required in med surg or specialty area.
  • Managed Care and/or Utilization Management Experience.
  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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