Current jobs related to Clinical Utilization Management Nurse Advisor - Harrisburg, Pennsylvania - CVS Health
-
Pharmacist Clinical Advisor
3 weeks ago
Harrisburg, Pennsylvania, United States CVS Health Full timeJob Title: Pharmacist Clinical AdvisorCVS Health is seeking a highly skilled Pharmacist Clinical Advisor to join our team. As a Clinical Advisor, you will play a critical role in supporting our Employer segment and working closely with the account team to deliver exceptional results.Key Responsibilities:Provide clinical consulting services to analyze drug...
-
Clinical Utilization Manager
4 weeks ago
Harrisburg, Pennsylvania, United States Capital BlueCross Full timeJob SummaryWe are seeking a highly skilled Clinical Utilization Manager to join our team at Capital BlueCross. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive the most appropriate and effective care.ResponsibilitiesConduct thorough reviews of acute and post-acute inpatient and...
-
Clinical Utilization Manager
3 days ago
Harrisburg, Pennsylvania, United States UPMC Full timeJob Summary:UPMC is seeking a skilled Clinical Utilization Manager to coordinate clinical and financial plans for patients. This is a full-time, day shift position with rotating weekend and holiday schedule.Main Responsibilities:• Reviews medical records daily to ensure patients continue to meet Level of Care (LOC) requirements and chart documentation...
-
Nurse Practitioner, Clinical Advisor
1 week ago
Harrisburg, Pennsylvania, United States UnitedHealth Group Full timeJob Title: Clinical Advisor, Nurse PractitionerAt UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone. We believe that everyone deserves the opportunity to live their healthiest life, regardless of their background or circumstances.The Clinical Advisor, Nurse Practitioner will play...
-
Clinical Utilization Management Specialist
6 days ago
Harrisburg, Pennsylvania, United States CVS Health Full timeAbout the Role:CVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a Utilization Management Nurse Consultant, you will play a critical role in coordinating, documenting, and communicating all aspects of the utilization/benefit management program.Key Responsibilities:Utilize clinical skills to coordinate, document, and...
-
Utilization Management Nurse Consultant
6 days ago
Harrisburg, Pennsylvania, United States CVS Health Full timeAt CVS Health, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. As a Utilization Management Nurse Consultant, you'll play a critical role in transforming our culture and accelerating our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable.Job SummaryThis is a...
-
Utilization Management Nurse Consultant
3 weeks ago
Harrisburg, Pennsylvania, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate, document,...
-
Client Services Coordinator
6 days ago
Harrisburg, Pennsylvania, United States Advisor Employee Services Full timeClient Services Administrator Job DescriptionAre you looking for a challenging role that utilizes your exceptional client service skills and allows you to work closely with clients daily? If you enjoy developing long-term relationships, constantly challenging yourself, and providing superior administrative support, we may have the perfect opportunity for...
-
Utilization Management Nurse Consultant
6 days ago
Harrisburg, Pennsylvania, United States CVS Health Full timeBring Your Expertise to CVS HealthAt CVS Health, we're committed to delivering exceptional healthcare services that put our patients at the forefront. As a Utilization Management Nurse Consultant, you'll play a vital role in ensuring that our patients receive the best possible care.Key Responsibilities:Apply critical thinking and clinical expertise to make...
-
Clinical Care Coordinator
7 days ago
Harrisburg, Pennsylvania, United States UPMC Full timeCare Manager Job DescriptionThe Care Manager at UPMC is responsible for coordinating the clinical and financial plan for patients. This involves performing overall utilization management, resource management, discharge planning, and post-acute care referrals and authorizations. The Care Manager works with a multi-disciplinary team in resource management,...
-
Utilization Management Clinician
2 weeks ago
Harrisburg, Pennsylvania, United States Capital BlueCross Full timeJob SummaryCapital Blue Cross is seeking a highly skilled Utilization Management Clinician to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive the necessary care and services to achieve optimal health outcomes.Key ResponsibilitiesConduct thorough clinical reviews of...
-
Care Manager
7 days ago
Harrisburg, Pennsylvania, United States UPMC Full timeJob Summary:UPMC is seeking a Part-time Care Manager to coordinate the clinical and financial plan for patients. This role involves overall utilization management, resource management, discharge planning, and post-acute care referrals and authorizations.Responsibilities:Reviews medical records daily to ensure patients continue to meet LOC requirements and...
-
Clinical Nurse Consultant
2 weeks ago
Harrisburg, Pennsylvania, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Clinical Nurse Consultant to join our team. As a key member of our Utilization Management department, you will play a critical role in coordinating, documenting, and communicating all aspects of our utilization/benefit management program.As a Clinical Nurse Consultant, you will utilize your clinical skills to apply...
-
Clinical Nurse Consultant
2 weeks ago
Harrisburg, Pennsylvania, United States CVS Health Full timeJob Title: Utilization Management Nurse ConsultantCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing unnecessary costs.Key Responsibilities:Utilize clinical expertise to...
-
Clinical Pharmacist
5 days ago
Harrisburg, Pennsylvania, United States Capital BlueCross Full timeJob SummaryCapital BlueCross is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will be responsible for developing, maintaining, and evaluating pharmacy clinical initiatives and utilization management programs to ensure cost-effective and quality pharmaceutical services for our plan members.Key...
-
Clinical Pharmacist
4 weeks ago
Harrisburg, Pennsylvania, United States Capital BlueCross Full timeJob SummaryCapital BlueCross is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will be responsible for developing, maintaining, and evaluating pharmacy clinical initiatives and utilization management programs to ensure cost-effective and quality pharmaceutical services for our plan members.Key...
-
Clinical Pharmacist
4 weeks ago
Harrisburg, Pennsylvania, United States Capital BlueCross Full timeJob SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team at Capital BlueCross. As a key member of our pharmacy team, you will be responsible for developing, maintaining, and evaluating pharmacy clinical initiatives and utilization management programs to ensure high-quality and cost-effective pharmaceutical services for our members.Key...
-
Clinical Pharmacist
2 weeks ago
Harrisburg, Pennsylvania, United States Capital BlueCross Full timeAbout the RoleCapital Blue Cross is seeking a highly skilled Clinical Pharmacist to join our team. As a key member of our pharmacy team, you will be responsible for developing, maintaining, and evaluating pharmacy clinical initiatives and utilization management programs to ensure high-quality and cost-effective pharmaceutical services for our plan...
-
Truck Service Advisor Position
6 days ago
Harrisburg, Pennsylvania, United States TravelCenters of America Full timeTruck Service Advisor Job DescriptionAt TravelCenters of America, we're seeking a skilled Truck Service Advisor to join our team. As a Truck Service Advisor, you will provide exceptional service to customers by utilizing your extensive knowledge of our products and services. Your primary responsibilities will include writing work orders, suggestive selling,...
-
Insurance Advisor
7 days ago
Harrisburg, Pennsylvania, United States Griffin Agency Full timeJob DescriptionWe are an insurance technology and distribution platform that is revolutionizing the industry. Our innovative approach allows us to issue policies in under one minute, making us one of the top distributors of digital life insurance policies worldwide. Our in-house marketing team generates exclusive client requests for our advisors, providing a...
Clinical Utilization Management Nurse Advisor
2 months ago
Company Overview
At CVS Health, we are dedicated to a singular mission: to bring our heart to every moment of your health. Our commitment is to provide enhanced, human-centric healthcare solutions that adapt to a rapidly evolving landscape.
Position Summary
The Utilization Management department operates around the clock, and the work schedule may encompass weekends, holidays, and evening shifts. In this role, you will leverage your clinical expertise in a collaborative framework to:
- Assess, plan, implement, coordinate, monitor, and evaluate healthcare service options for our members.
- Analyze reports to identify trends, metrics, and issues related to assignments.
- Serve as the primary contact for front-line staff inquiries regarding cases.
- Facilitate RN/MD rounds as needed.
- Assist with complex case reviews and facility-related issues.
- Gather clinical data and apply relevant clinical criteria, guidelines, and policies to make informed coverage determinations.
- Communicate effectively with providers and other stakeholders to enhance care and treatment.
- Identify members for referral opportunities to integrate additional services and programs.
- Promote the quality and effectiveness of healthcare services and benefit utilization.
- Consult with internal and external partners regarding the administration of utilization and benefit management functions.
Work Environment
This position typically involves an office setting with expectations for productivity and quality. The role requires close inspection of both handwritten and digital documents, as well as extended periods of sitting, communication via telephone, and computer usage.
Qualifications
Required:
- A minimum of 3 years of experience as a Registered Nurse.
- At least 1 year of experience in Managed Care.
- Experience in managing census, adjusting team assignments, and generating reports for at least 1 year.
- Proven experience in managing flexible scheduling for teams and quality report management for at least 1 year.
- Active and unrestricted RN licensure in your state of residence, with multi-state/compact privileges.
Preferred:
- 3+ years of clinical experience in acute or post-acute settings.
- An Associate's Degree is required; a BSN is preferred.
Compensation and Benefits
The pay range for this role typically falls between $54,000 and $136,600 annually. This range represents the base salary for all positions within the job grade. Actual salary offers will depend on various factors, including experience, education, and geographic location.
In addition to competitive compensation, CVS Health offers a comprehensive benefits package, including:
- Medical, dental, and vision coverage.
- 401(k) retirement savings plan and Employee Stock Purchase Plan.
- Fully-paid term life insurance and short-term/long-term disability benefits.
- Numerous well-being programs and education assistance.
- Paid Time Off (PTO), vacation pay, and paid holidays.
CVS Health is an equal opportunity and affirmative action employer. We do not discriminate 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 law.
