Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 15 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $32 - $68 / 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.

Apply Now

Find Similar Remote Jobs

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

• Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical 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, and programs • Promote quality and effective healthcare services and benefit utilization • Consult with and provide expertise to internal and external constituents regarding utilization and benefit management • Work in a typical office environment with productivity and quality expectations while working from home • Navigate multiple systems and communicate through email, calendars, Teams, messaging, and virtual meetings • Collaborate using Microsoft Office 365 applications or similar tools • Troubleshoot common technical issues and contact IT for unresolved issues

🎯 Requirements

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Active, current, unrestricted RN licensure in state of residence • 2+ years of clinical experience in med surg or specialty area • Associates Degree required • Managed Care experience preferred, especially Utilization Management • Preference for candidates residing in PST zones • Direct/hardwired internet connection to modem/router within 7 feet of computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Ability to provide own workspace furniture • Proficiency with multiple monitors and multiple applications • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to use secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues • Effective verbal and written communication skills • Ability to work weekends, holidays, and evening hours in a 24/7 operation • Ability to perform close inspection of handwritten and computer-generated documents and PC monitors • Ability to sit for extended periods, talk on the telephone, type, multitask, prioritize, and adapt to a fast-paced changing environment

🏖️ 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 (keyboard, monitor, computer, headset, etc.) • Remote work from home

📊 Check your resume score for this job

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

Upload Resume