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CVS Health
CVS Health
Asigurare de sănătateAsistență medicalăComerț cu amănuntul
CVS Health este o companie americană din domeniul sănătății, care activează în servicii medicale, asigurări de sănătate, gestionarea beneficiilor farmaceutice și farmacii cu vânzare cu amănuntul. Prin companii precum Aetna și CVS Caremark, aceasta sprijină acoperirea medicală, accesul la medicamente eliberate pe bază de rețetă, gestionarea afecțiunilor, medicamentele specializate și serviciile de farmacie prin comenzi prin poștă. Farmaciile sale de proximitate și serviciile extinse de îngrijire sunt concepute pentru a-i ajuta pe oameni să acceseze mai ușor și mai accesibil servicii medicale esențiale. CVS Health reunește asigurările, farmacia și serviciile de sănătate pentru a sprijini persoanele și comunitățile pe tot parcursul experienței lor de îngrijire.
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Remote Utilization Management Nurse Consultant

Review complex Medicare spine cases and make coverage decisions for CVS Health. Coordinate evidence-based care remotely with providers and care teams.

USStatele Unite ale AmericiiALAlabamaAZArizonaCACaliforniaCOColoradoFLFloridaIDIdahoILIllinoisIAIowaKYKentuckyLALouisianaMEMaineMAMassachusettsMIMichiganMNMinnesotaMSMississippiNVNevadaNJNew JerseyNYNew YorkNCCarolina de NordOHOhioOKOklahomaOROregonPAPennsylvaniaSCCarolina de SudTNTennesseeTXTexasWIWisconsin
29 $ – 62 $ / oră
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăConsultant

Descriere

  • Review clinical cases and determine coverage using evidence-based guidelines.
  • Coordinate appropriate treatment with providers and care teams.
  • Use clinical judgment to guide utilization and benefit management decisions.
  • Identify ways to improve care quality and member outcomes.
  • Provide clinical guidance to internal and external stakeholders.
  • Apply clinical expertise in a collaborative, non-bedside position.
  • Contribute to care coordination and healthcare quality.

Cerințe

  • Hold an active, unrestricted RN license in your state of residence.
  • Have at least three years of RN experience, including at least one year in medical-surgical nursing.
  • Demonstrate strong clinical assessment and decision-making skills.
  • Have experience with Microsoft Office, including Outlook, Teams, and Excel.
  • Be available Monday through Friday, 9:00 a.m. to 5:30 p.m. in your time zone.
  • Be able to work some holidays and evening hours; Utilization Management operates 24 hours a day, seven days a week.
  • Hold an Associate Degree in Nursing.
  • Use a direct, hardwired internet connection to a modem or router within seven feet of the computer.
  • Have internet service with at least 25 Mbps download and 3 Mbps upload speeds.
  • Do not use Wi-Fi or satellite internet.
  • Maintain a quiet, secure, private home workspace that meets CVS Health and HIPAA guidelines.
  • Work from the state and city where you currently reside.
  • Provide workspace furniture, such as a desk or standing desk.
  • Be able to use multiple monitors and navigate multiple applications.
  • Be comfortable with digital communications, including email, calendar invitations, Teams messages, and virtual meetings.
  • Have experience with Microsoft Office 365 or similar Google Workspace applications.
  • Be able to access secure systems, including VPN and EHR portals.
  • Follow computer security practices, including locking screens, using strong passwords, and recognizing suspicious emails or links.
  • Troubleshoot common technical issues and contact IT when they cannot be resolved.
  • Be open to learning new skills as the workplace evolves.
  • Utilization Management or prior authorization experience, a managed care background, familiarity with MedCompass, and ambulatory surgery experience are preferred.
  • A BSN is preferred.

Beneficii

  • Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.
  • Medical coverage.
  • Dental coverage.
  • Vision coverage.
  • Paid time off.
  • Retirement savings options.
  • Wellness programs.
  • Resources supporting physical, emotional, and financial well-being.
  • Company-provided equipment, including a keyboard, monitor, computer, and headset.
  • Remote work arrangement.

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