Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 5 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $26 - $74 / 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

• Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care • Collaborate with providers and care teams to facilitate appropriate treatment and care planning • Identify opportunities to improve quality of care, member outcomes, and healthcare utilization • Connect members with additional programs and resources supporting their healthcare needs • Serve as a clinical resource for internal and external stakeholders • Work within a 24/7 utilization management operation, with possible evening, weekend, and holiday schedules • Collaborate frequently with providers, members, and interdisciplinary healthcare teams • Meet productivity and quality expectations in a remote, computer-based role

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of adult acute care and/or critical care nursing experience • Strong clinical assessment, critical thinking, and decision-making skills • Excellent verbal and written communication skills • Ability to multitask and work effectively in a fast-paced environment • Proficiency navigating multiple computer systems and applications • Associate Degree in Nursing required • Experience with Med-Surg or specialty nursing preferred • Managed Care or Utilization Management experience preferred • Residence in the Eastern Time Zone preferred • BSN preferred • Ability 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 residing • Ability to use multiple monitors and applications simultaneously • Ability to use 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 screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot common technical issues and contact IT when needed • Openness to learning new skills as the workplace evolves

🏖️ 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 work equipment, including keyboard, monitor, computer, and headset • Remote work from home • CVS Health bonus, commission or short-term incentive program eligibility

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