Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 19 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.

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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, or programs • Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization • Consult with and advise internal and external constituents on utilization and benefit management coordination and administration • Work in a typical office environment with productivity and quality expectations • Perform sedentary work involving extended sitting, telephone conversations, listening, and computer typing • Navigate multiple systems and keyboard efficiently

🎯 Requirements

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Active, current and unrestricted RN licensure in state of residence • Associate's Degree required • 2+ years of clinical experience in med-surg or a specialty area • Managed Care experience preferred, especially Utilization Management • Preference for candidates residing in PST zones • Ability to work weekends, holidays, and evening hours in a 24/7 operation • Direct/hardwired internet connection to modem/router within 7 feet of computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Proficiency navigating multiple systems and applications • Ability to use digital communication tools including email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, manage strong passwords, and identify suspicious emails or links • Ability to troubleshoot common technical issues • Effective verbal and written communication skills • Ability to perform close inspection of handwritten and computer-generated documents and PC monitors • Ability to 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 • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program eligibility

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