Utilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantWork At Home-West Virginia, WV$32.01–$68.55 / hourCommunicates 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. 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.
Plan Sponsor Service Consultant, Operations CVS Health CorpPlan Sponsor Service Consultant, OperationsWork At Home, WV$17–$34.15 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. PSSC's are required to perform multi-system research, make outbound calls and process provider updates for new and existing members.
Mgr, Business Consultant CVS Health CorpMgr, Business ConsultantWV$60,300–$132,600 / yearThe Manager will be responsible for ensuring the accuracy, completeness, and timeliness of encounter data submissions while partnering closely with internal business and technical teams, as well as external vendors, to meet regulatory and operational requirements across multiple states. As the Dual Special Needs Plan (DSNP) business continues to expand, we are seeking an experienced Manager, Encounter Data & State Submission Operations to lead the end-to-end management of encounter and claims data submissions to state agencies.
NewNurse U.S. Department of LaborNurseCharleston, WV$89,508–$133,142 / yearThis education must have been accredited by the Commission on Collegiate Nursing Education (external link), Council on Accreditation of Nurse Anesthesia Educational Programs (external link), Accreditation Commission for Midwifery Education (external link), or an accrediting body recognized by the U.S. Department of Education (external link) at the time the degree was obtained. Additional License Requirements for Advanced Practice Nurse Positions: Applicants for Advanced Practice Nurse positions must be licensed or registered by a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States in the clinical specialty required by the position.