Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 3 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 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

• Review clinical cases and make coverage determinations using evidence-based guidelines • Collaborate with providers and care teams to coordinate appropriate treatment • Apply clinical judgment to utilization and benefit management decisions • Identify opportunities to improve care quality and member outcomes • Serve as a clinical resource across internal and external stakeholders • Work in a remote, non-bedside utilization management role focused on Medicare complex spine cases

🎯 Requirements

• Active, unrestricted RN license in the state of residence • 3+ years of RN experience, including 1+ year in Med/Surg • Strong clinical assessment and decision-making skills • Experience with Microsoft Office (Outlook, Teams, Excel) • Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone; schedules may include holidays and evening hours • Associate Degree in Nursing • Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of the 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 living • Must provide own workspace furniture, such as a desk or standing desk • Comfortable setting up and using multiple monitors and navigating multiple applications • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking the screen, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently and contact IT when needed • Openness to learning new skills as the workplace evolves • Utilization Management or Prior Authorization experience preferred • Managed care background preferred • Familiarity with MedCompass preferred • Ambulatory surgery experience preferred • BSN preferred

🏖️ 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.)

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