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.
Remote Utilization Management Nurse Consultant at CVS Health
Review Medicare cases and make evidence-based coverage decisions as a remote Utilization Management Nurse Consultant at CVS Health. Help improve care quality and member outcomes through clinical collaboration and care coordination.
Descriere
- Assess clinical cases and determine coverage using evidence-based guidelines.
- Work with providers and care teams to coordinate appropriate treatment.
- Use clinical judgment to guide utilization and benefit management decisions.
- Find ways to improve care quality and member outcomes.
- Provide clinical guidance to internal and external stakeholders.
- Apply clinical expertise in a collaborative role outside bedside care.
- Support member 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.
- Bring strong clinical assessment and decision-making skills.
- Have experience using Microsoft Office, including Outlook, Teams, and Excel.
- Be available Monday through Friday, 9:00 a.m. to 6:00 p.m. in your time zone; schedules may include holidays and evening hours.
- Have an Associate Degree in Nursing.
- Use a direct, hardwired internet connection located within seven feet of the modem or router.
- Have internet service with at least 25 Mbps download and 3 Mbps upload speeds.
- Do not use Wi-Fi or satellite internet service.
- Maintain a quiet, secure, private home workspace that meets CVS Health and HIPAA guidelines.
- Work from the state and city where you currently reside.
- Be able to use multiple monitors and applications at the same time.
- Be comfortable using digital communication channels and virtual meetings.
- Have experience with Microsoft Office 365 or similar Google Workspace applications.
- Be able to access secure systems such as VPN and EHR portals.
- Follow computer and password security practices and identify suspicious emails or links.
- Be able to resolve common technical issues independently.
- Be open to learning new skills.
- A BSN is preferred.
Beneficii
- Eligibility for CVS Health bonus, commission, or short-term incentive programs in addition to base pay.
- Medical, dental, and 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.