Utilization Management Nurse Consultant

Job not on LinkedIn

🕒 3 days ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

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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

• Review and assess clinical information to support coverage and care decisions • Apply clinical guidelines, policies, and professional judgment across the continuum of care • Collaborate with providers and interdisciplinary teams to coordinate treatment and services • Identify opportunities for care management referrals and member support programs • Promote quality, effective healthcare utilization, and positive member outcomes • Serve as a clinical resource for internal and external stakeholders

🎯 Requirements

• Active, unrestricted RN license in state of residence • Minimum 2 years of RN experience in adult acute care or critical care • Strong clinical assessment, communication, and computer skills • Ability to thrive in a fast-paced, high-volume environment • Associates Degree in Nursing • Preferred Qualifications: Experience in Medical-Surgical or specialty nursing, Managed Care and/or Utilization Management experience, BSN preferred

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • CVS Health bonus, commission or short-term incentive program