![CVS Health](https://media.trabajo.org/img/noimg.jpg)
Utilization Management Nurse Consultant
3 weeks ago
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state.
No travel is required.
As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.
The UM Nurse Consultant job duties include (not all encompassing):
- Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- 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.
Required Qualifications
- Must have active, current and unrestricted RN licensure in state of residence
- 3+ years of acute hospital clinical experience as an RN with preference for medical-surgical and ICU experience (team is not accepting applicants whose only acute care experience is in behavioral health)
- Must be able to work hours: Monday through Thursday 8:00am to 4:30pm and Friday 8:30am to 5:00pm with occasional weekends and holidays hours from 8:00am to 4:30pm in time zone of residence.
Preferred Qualifications
-1+ years experience Utilization Review experience
-1+ years experience Managed Care
- Strong telephonic communication skills
-1+ years experience with Microsoft Office Suite
- Team prefers candidates in Arizona Time Zone
Education
Associates Degree required
BSN preferred
Pay Range
The typical pay range for this role is:
$26.01 - $56.14
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 08/12/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
-
Utilization Management Nurse Consultant
4 weeks ago
Phoenix, United States CVS Health Full timeBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...
-
Utilization Management Nurse Consultant
3 weeks ago
Phoenix, United States CVS Health Full timeBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...
-
Nurse Consultant for Utilization Management
1 week ago
Phoenix, Arizona, United States CVS Health Full timeAbout CVS HealthAt CVS Health, we are dedicated to a singular mission: to enhance every moment of your health journey. Our commitment is to provide human-centric healthcare solutions in a rapidly evolving landscape. We believe that the manner in which we deliver our services is as crucial as the services themselves. Our Heart At Work Behaviors embody this...
-
Senior Construction Inspector
18 hours ago
Phoenix, Arizona, United States Consultant Engineering, Inc Full timeJob SummaryConsultant Engineering, Inc. (CEI) is a professional engineering firm headquartered in Phoenix, Arizona, with additional offices in Tucson and Gilbert, Arizona. As one of the Southwest's largest construction management firms, we provide professional right of way (appraisals, acquisition and relocation services) and land surveying services. CEI...
-
Clinical Utilization Review Nurse
1 week ago
Phoenix, Arizona, United States Innovative Care Management, Inc. Full timePosition Overview:Under the supervision of the Manager of the Utilization Review Program, the Utilization Review (UR) Nurse plays a crucial role in ensuring the efficient and precise evaluation of initial medical necessity assessments throughout the preauthorization and retrospective review processes.Work Environment:This position is remote; however, due to...
-
Clinical Utilization Review Nurse
1 week ago
Phoenix, Arizona, United States Innovative Care Management, Inc. Full timePosition Overview:Under the supervision of the Manager of the Utilization Review Program, the Utilization Review (UR) Nurse plays a crucial role in ensuring the efficient and precise management of initial medical necessity evaluations throughout the preauthorization and retrospective review processes.Work Environment:This position is remote; however, due to...
-
Clinical Utilization Review Nurse
1 week ago
Phoenix, Arizona, United States Innovative Care Management, Inc. Full timePosition Overview:Under the guidance of the Manager of the Utilization Review Program, the Utilization Review (UR) Nurse plays a crucial role in ensuring the efficient and precise management of initial medical necessity evaluations throughout the preauthorization and retrospective review processes.Work Environment:This position is primarily remote; however,...
-
Phoenix, Arizona, United States CVS Health Full timeAbout CVS HealthAt CVS Health, we are united by a common mission: to bring compassion to every aspect of health care. Our commitment is to provide personalized, accessible, and affordable health solutions in a rapidly evolving landscape.Position OverviewThis role as a Utilization Management Nurse Consultant is entirely remote, allowing flexibility for...
-
Phoenix, Arizona, United States CVS Health Full timeAbout CVS HealthAt CVS Health, we are united by a common mission: to enhance the health and well-being of our communities. Our commitment to providing compassionate, personalized care is at the core of everything we do.Position OverviewThe role of the Utilization Management Nurse Consultant is a fully remote position, allowing candidates to work from any...
-
Utility Project Manager
4 weeks ago
Phoenix, United States Maricopa County Full timePosting Date 08/15/24 Application Deadline 08/22/24 Pay Range $26.00 - $41.00 hourly Salary offers are based on the candidate's equivalent experience and internal equity with other employees within the same job classification. This position is eligible for overtime compensation for all hours worked over 40 in the designated workweek. Job Type ...
-
Healthcare Nursing Consultant
1 week ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timePosition Overview: The Division of Fee For Service Management (DFSM) is seeking a dedicated professional to join our team as a Public Health Nursing Consultant. This role is essential in providing oversight and technical support to ensure adherence to contractual, regulatory, and statutory requirements for FFS members' physical and behavioral health...
-
Nurse (Risk Management Consultant)
4 months ago
Phoenix, United States Indian Health Service Full timeParticipates in the development of innovative, evidence-based approaches to the establishment enhancement, modification, and/or improvement of care with a focus on minimizing the risk of harm to patients, liability exposure of our healthcare providers, and financial loss to the agency. Demonstrates knowledge of current concepts and principles of...
-
Nurse (Risk Management Consultant)
4 months ago
Phoenix, Arizona, United States Indian Health Service Full timeParticipates in the development of innovative, evidence-based approaches to the establishment enhancement, modification, and/or improvement of care with a focus on minimizing the risk of harm to patients, liability exposure of our healthcare providers, and financial loss to the agency. Demonstrates knowledge of current concepts and principles of performance...
-
Residential Leasing Consultant
1 week ago
Phoenix, Arizona, United States Management Support Full timeWe are excited to announce an opportunity for a Residential Leasing Consultant at our esteemed Management Support property.Position Overview:As a Leasing Consultant, you will play a pivotal role in our community, engaging with potential residents and showcasing the unique features of our apartments. We seek individuals who possess strong sales acumen and a...
-
Utilization Management
4 weeks ago
Phoenix, Arizona, United States tango Full timeThe UM Clinical Support Specialist plays a vital role in assisting the Director and Supervisor of UM by collecting, analyzing, and reporting data. This role involves maintaining data logs related to utilization and productivity, developing and monitoring various reports, and providing support to the clinical team by handling inbound and outbound calls that...
-
Utility Coordination Project Supervisor
1 week ago
Phoenix, Arizona, United States Maricopa County Full timePosition Overview Are you ready to take on a challenging role in utility project management? As a Utility Project Manager, you will be responsible for overseeing complex utility coordination, design, and relocation projects. This position demands a high level of accountability for budget management related to utility design and relocation within...
-
Full Time Leasing Consultant
3 months ago
Phoenix, United States Anza Management Full timeThank You for your interest in Anza Management, we are looking for a full-time Leasing Consultant.Job Summary: The Leasing Consultant as initial contact between the public and the company, strives to project the quality of our product. Successfully leases apartments by meeting customer needs. Assists in marketing the property and generating traffic. Helps...
-
Construction/Lead Inspector
3 months ago
Phoenix, United States Consultant Engineering, Inc Full timeJob Description Consultant Engineering, Inc. (CEI) i s an Arizona owned and operated professional engineering firm headquartered in Phoenix, Arizona with additional offices in Tucson and Gilbert, Arizona. As one of the Southwest's largest construction management firms, we also provide professional right of way (appraisals, acquisition and relocation...
-
Clinical Review Nurse
1 week ago
Phoenix, Arizona, United States Innovative Care Management, Inc. Full timePosition Overview:Under the supervision of the Manager of the Utilization Review Program, the Clinical Review Nurse is tasked with ensuring timely and precise evaluation of initial medical necessity assessments throughout the preauthorization and retrospective review processes.Work Environment:This role is designated as remote; however, due to payroll and...
-
Client Engagement Manager Digital Consulting
1 month ago
Phoenix, Arizona, United States Burns & McDonnell Full timeDescriptionThe Client Engagement Manager Digital Consulting role within 1898 & Co., a part of Burns & McDonnell, will partner with our customers in the Electric Utility space to understand their critical business challenges and implement technology-focused solutions that build a brighter future. This role will be highly engaged with driving targeted...