Territory Management Consultant
EMC Insurance Companies
Utilization Management Nurse Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Missouri • 🇺🇸 United States
Visit company websiteSalary
💰 $29 - $62 per hour
Job Level
Mid-LevelSenior
About the role
- Utilize clinical experience and skills to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
- Gather clinical information and apply clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
- Communicate with providers and other parties to facilitate care/treatment
- Identify members for referral opportunities to integrate with other products, services and/or programs
- Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Work schedules will include weekends, holidays, and evening hours; work is sedentary involving periods of sitting, talking, listening, typing on the computer
- Meet productivity and quality expectations in a typical office working environment
Requirements
- MUST LIVE IN EASTERN STANDARD TIME ZONE
- 4-5 years of experience as a Registered Nurse in adult acute care, critical care , emergency or med/surg setting
- Active current and unrestricted RN licensure in state of residence
- Ability to work weekends, holidays, and evening hours (Utilization Management is a 24/7 operation)
- Proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written
- Longevity in previous roles
- Associates Degree in nursing required (BSN preferred)
Benefits
- Affordable medical plan options
- a 401(k) plan (including matching company contributions)
- 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
- Paid time off
- flexible work schedules
- family leave
- dependent care resources
- colleague assistance programs
- tuition assistance
- retiree medical access
- eligibility for CVS Health bonus, commission or short-term incentive program
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical assessmentcare planningcoverage determinationclinical criteria applicationutilization managementnursing skillspatient care coordinationhealthcare services evaluationbenefit managementkeyboard proficiency
Soft skills
effective communicationinterpersonal skillsorganizational skillsteam collaborationproblem-solvingattention to detailadaptabilitytime managementcustomer servicelongevity in roles
Certifications
Registered Nurse licensureAssociates Degree in NursingBSN (preferred)
