Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 12 hours ago

🌽 Illinois – Remote

🌽 Illinois – 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 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 and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work a Monday-Friday schedule from 8:00 AM to 5:00 PM CST, with 12 weekend shifts per year, occasional weekend shifts, and 2 holidays per year, subject to change

🎯 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 • Associates Degree required • 2+ years of clinical experience in med surg or specialty area • Managed Care experience preferred, especially Utilization Management • Preference for those residing in CST zones • 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, lock computer screens, 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 and private designated home work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • 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 monitor • Ability to sit for extended periods, talk on the telephone, and type on a computer • Proficiency with computer skills, navigating multiple systems, and keyboarding • Effective verbal and written communication skills

🏖️ 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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