Full-Time
Utilization Management Nurse Consultant
Posted on 11/20/2024
CVS Pharmacy
10,001+ employees
Retail pharmacy and healthcare services provider
Compensation Overview
$26.01 - $56.14Hourly
Mid
Company Historically Provides H1B Sponsorship
Seattle, WA, USA + 17 more
More locations: Anderson, SC, USA | Remote in USA | Lake St Louis, MO, USA | Barren County, KY, USA | Richmond, VA, USA | Hillsboro, OR, USA | Tukwila, WA, USA | St. Louis, MO, USA | Richland, WA, USA | Springfield, TN, USA | Gilbert, AZ, USA | Bloomington, IN, USA | Wilmington, NC, USA | Chandler, AZ, USA | Evansville, IN, USA | Glendale, AZ, USA | Swansea, IL, USA
Includes multiple locations across various states, with Ohio as a work from home option.
- 3+ years of experience as a Registered Nurse
- Must hold active and unrestricted RN licensure in state of residence
- 1+ year(s) of Med/Surg experience
- 1+ year(s) of inpatient utilization experience
- 1+ year(s) of experience with Microsoft Office applications (Outlook, Teams, Excel)
- Experience Medicare/Medicaid populations
- MCG experience
- Managed care experience
- UM Certification
- MedCompass
- Associates degree required
- BSN preferred
- 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 model 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, positioning itself as a significant player in the healthcare sector with a commitment to enhancing people's health.
Company Stage
N/A
Total Funding
N/A
Headquarters
Woonsocket, Rhode Island
Founded
N/A
6 month growth
↓ -2%1 year growth
↓ -2%2 year growth
↓ -2%
Simplify's Take
What believers are saying
- The availability of updated flu and COVID-19 vaccines at CVS Pharmacy and MinuteClinic locations nationwide positions the company as a key player in public health initiatives.
- The Health Zones funding and collaboration with local organizations in Fresno highlight CVS Pharmacy's role in improving community health outcomes.
- The introduction of a new store brand for snacks, beverages, and groceries could attract a broader customer base and increase in-store sales.
What critics are saying
- The competitive landscape in the retail pharmacy sector is intense, with major players like Walgreens and Rite Aid posing significant challenges.
- The expansion into grocery and snack products may dilute CVS Pharmacy's brand identity as a healthcare provider.
What makes CVS Pharmacy unique
- CVS Pharmacy's integration of digital tools for scheduling vaccinations and accepting walk-ins offers a seamless and convenient experience for customers, setting it apart from competitors.
- The company's Health Zones initiative, which focuses on community health and access to healthy food, demonstrates a commitment to social responsibility that goes beyond traditional pharmacy services.
- CVS Pharmacy's recent launch of a new store brand for snacks, beverages, and groceries diversifies its product offerings, making it a one-stop shop for consumers.
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