Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 hour 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.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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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

• 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 • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with and advise internal and external constituents on utilization and benefit management • Work in a 24/7 utilization management operation with weekend, holiday, and evening schedules • Perform work in a typical office environment with productivity and quality expectations • Inspect handwritten and computer-generated documents and PC monitor content • Sit for extended periods, talk on the telephone, type, multitask, prioritize, and adapt to a fast-paced environment

🎯 Requirements

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Active, current, and unrestricted RN licensure in state of residence • Availability for weekends, holidays, and evening hours, including approximately 12 weekend days/year, 2–3 late shifts, and 1 major and 1 minor holiday/year • Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals, secure computer access, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently and contact IT for unresolved issues • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 50 Mbps download and 5 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 obtain required internet speeds and follow Work From Home requirements • Associates Degree required • Effective verbal and written communication skills • Computer proficiency, including navigating multiple systems and keyboarding

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

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