Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 2 hours ago

🌪️ Kansas – Remote

🌪️ Kansas – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

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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 and assess clinical information to support coverage determinations and care coordination • Apply clinical guidelines, policies, and professional judgment to utilization management decisions • Collaborate with providers and interdisciplinary teams to facilitate appropriate treatment and services • Identify opportunities for care management referrals and member support programs • Promote quality, cost-effective healthcare delivery and benefit utilization • Provide utilization management expertise and support to internal and external stakeholders • Work in a 24/7 operation with schedules that may include evenings, weekends, and holidays • Meet productivity and quality performance expectations in a remote office environment

🎯 Requirements

• Active, unrestricted RN license in your state of residence • Minimum 2 years of RN experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • Strong communication, multitasking, and computer skills • Experience in Medical-Surgical nursing or a specialty clinical area preferred • Managed Care and/or Utilization Management experience preferred • Candidates located in the Central Time Zone preferred • 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 • Ability to use multiple monitors and navigate multiple applications • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot common technical issues independently

🏖️ 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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