Utilization Management Nurse Consultant

Job not on LinkedIn

🕒 5 days ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $26 - $74 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review clinical information and apply evidence-based criteria to make utilization and coverage recommendations • Collaborate with providers and healthcare teams to support appropriate treatment plans and care coordination • Identify opportunities to improve healthcare quality, outcomes, and benefit utilization • Refer members to additional programs and services supporting their healthcare needs • Serve as a clinical resource for internal and external stakeholders • Work schedules may include evenings, weekends, and holidays in a 24/7 operation • Work from a designated home workspace and comply with Work From Home, HIPAA, internet, security, and equipment requirements

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in an adult acute care or critical care setting • Strong communication, critical thinking, and multitasking skills • Proficiency navigating multiple computer systems • Associates Degree in Nursing Required • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 mbs download and 3 mbs upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Ability to use multiple monitors and navigate multiple applications simultaneously • Ability to use digital communication channels including email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills as the workplace evolves • Preferred: 2+ years of Med-Surg or specialty clinical experience • Preferred: Managed Care and/or Utilization Management experience • Preferred: candidates residing in Central or Eastern time zones • Preferred: BSN

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility • Company-provided equipment including keyboard, monitor, computer, and headset • Remote work from home

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