Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 4 hours ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $26 - $56 / 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 to integrate with other products, services, and programs • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with and provide expertise to internal and external constituents regarding utilization and benefit management • Work in a 24/7 utilization management operation, including weekends, holidays, and evening hours • Perform computer-based work involving extended sitting, telephone communication, typing, and close document/monitor inspection • Navigate multiple systems and applications while meeting productivity and quality expectations

🎯 Requirements

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Active, current and unrestricted RN licensure in the state of residence • 2+ years of clinical experience in med-surg or a specialty area • Associate degree required • 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 a modem/router within 7 feet of the computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • Quiet, secure, private and HIPAA-compliant designated home workspace • Must work within the state and city where currently residing • Proficiency navigating multiple systems and applications • Ability to use digital communication tools, virtual meetings, and multiple monitors • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to access secure systems such as VPN and EHR portals • Knowledge of computer security practices, strong passwords, and suspicious-link recognition • Ability to troubleshoot common technical and internet issues • Effective verbal and written communication skills • 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 well-being resources based on eligibility • CVS Health bonus, commission or short-term incentive program in addition to base pay • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work from home

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