Demo Consultant
Workiva
Cloud
Utilization Management Nurse Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Maryland • 🇺🇸 United States
Visit company websiteSalary
💰 $32 - $69 per hour
Job Level
JuniorMid-Level
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/guidelines, policies, procedures and clinical judgment to render coverage determinations/recommendations 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 and effectiveness of healthcare services and benefit utilization
- Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function
- Perform documentation and computer-based tasks in a typical office working environment, including prolonged sitting, telephone communication and typing on a PC
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; Bachelors in Science & Nursing preferred
- Utilization Management is a 24/7 operation; work schedules will include weekends, holidays, and evening hours
- Proficiency with computer skills, including navigating multiple systems and keyboarding
- Effective verbal and written communication skills
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- 2+ years clinical experience in med surg or specialty area (preferred)
- Managed Care experience preferred, especially Utilization Management
- Preference for those residing in EST zones
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- Eligible for a CVS Health bonus, commission or short-term incentive program
- No-cost wellness programs (wellness screenings, tobacco cessation, 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
- Competitive wages
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical assessmentcare coordinationcoverage determinationutilization managementdocumentationcomputer skillsnursingadult acute carecritical caremed surg
Soft skills
effective communicationmultitaskingprioritizationadaptabilityconsultationteam collaborationproblem-solvingorganizational skillsinterpersonal skillsjudgment
Certifications
Registered Nurse licensureAssociates DegreeBachelors in Science & Nursing
