Full-Time

Utilization Management Nurse Consultant

Posted on 12/20/2024

CVS Pharmacy

CVS Pharmacy

10,001+ employees

Retail pharmacy and healthcare services provider

Healthcare
Consumer Goods

Compensation Overview

$32.01 - $68.55Hourly

+ Bonus + Commission + Short-term Incentive Program

Mid, Senior

Company Historically Provides H1B Sponsorship

Remote in USA

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Requirements
  • 3+ years of experience as a Registered Nurse
  • 1+ years of clinical experience in acute or post acute setting
  • Must have active current and unrestricted RN licensure in state of residence
  • Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations.
Responsibilities
  • 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.

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, beauty items, and general merchandise. CVS Health also functions as a pharmacy benefits manager, serving over 75 million plan members, and has a senior pharmacy care business that assists more than one million patients each year. This integrated approach allows CVS Health to deliver affordable health management solutions, improving access to quality care and health outcomes while aiming to reduce overall healthcare costs. Unlike many competitors, CVS Health combines retail pharmacy services with clinical care and pharmacy benefits management, making it a significant player in the healthcare sector with a goal of helping individuals achieve better health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

1963

Growth & Insights
Headcount

6 month growth

0%

1 year growth

0%

2 year growth

0%
Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of at-home health testing aligns with consumer-driven healthcare trends.
  • Simplified digital scheduling for vaccinations enhances customer convenience and service efficiency.
  • Growing market for over-the-counter hearing aids presents new product opportunities for CVS.

What critics are saying

  • DOJ's civil complaint poses legal and financial risks for CVS.
  • Allegations of violating opioid regulations could damage CVS's reputation and consumer trust.
  • Competition from Walmart and Amazon in at-home health tests may impact CVS's market share.

What makes CVS Pharmacy unique

  • CVS offers a wide range of health services, including walk-in clinics and vaccinations.
  • The company collaborates with local police for drug collection, enhancing community engagement.
  • CVS maintains free cash-back services, differentiating from competitors charging fees.

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