Utilization Management Nurse Consultant – Weekends, 4-10 Hour Shifts

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🕒 5 days ago

🥔 Idaho, North Carolina, +2 more states – Remote

🥔 Idaho – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote 🤠 Texas – Remote

💵 $26 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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 determinations • Apply clinical guidelines, policies, and sound judgment across the care continuum • Collaborate with providers and care teams to coordinate treatment plans • Identify opportunities to enhance quality, efficiency, and member outcomes • Refer members to additional programs and services as appropriate • Serve as a clinical resource within utilization/benefit management

🎯 Requirements

• Active, unrestricted RN license in state of residence • 3+ years of RN experience • 1+ year Med/Surg experience • Proficiency with Microsoft Office (Outlook, Teams, Excel) • Willingness to work required schedule post-training • Prior Authorization or Utilization Management experience preferred • Managed care experience preferred • MedCompass experience preferred • Ambulatory surgery background preferred • BSN preferred (Associate’s required)

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility