Utilization Management Nurse Consultant

Job not on LinkedIn

🕒 October 16

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Assess, plan, implement, coordinate, monitor, and evaluate healthcare service and benefit options for members • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and judgment to render coverage determinations or recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services, or programs • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with internal and external constituents on utilization and benefit management coordination and administration • Work in a typical office environment with productivity and quality expectations • Perform close inspection of handwritten and computer-generated documents and PC monitor content • Sit for extended periods, talk on the telephone, listen, and type on a computer • Multitask, prioritize, and adapt to a fast-paced changing environment • Troubleshoot common technical issues and contact IT when needed

🎯 Requirements

• Must reside in Central Time, Mountain Time, or Pacific Time zones • Must have active current and unrestricted Registered Nurse (RN) licensure in state of residence • 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Must be available to work weekends, holidays, and evening hours as required by business needs • Associates Degree in Nursing or Nursing Diploma (Required) • Proficiency with computer skills, including navigating multiple systems and keyboarding • Effective verbal and written communication skills • Ability to work with multiple monitors and applications simultaneously • Ability to use Microsoft Office 365 applications or similar tools • Ability to log in to secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to resolve common technical issues independently • Must have or be able to obtain a direct/hardwired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload • Must maintain a quiet, secure, private, and HIPAA-compliant home workspace • Must work within the state and city where currently residing • Must provide own workspace furniture • Openness to learning new skills as the workplace evolves

🏖️ Benefits

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