Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 minute 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

• 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 across the continuum of care • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities to 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 in coordinating and administering utilization and benefit management • Work within a typical office environment with productivity and quality expectations while working remotely

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in adult acute care or critical care settings • Associate Degree in Nursing required • Preference for candidates in CST or EST time zones • Flexibility for evenings, weekends, and holidays 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 designated home work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Ability to perform close inspection of handwritten and computer-generated documents and a PC monitor • Ability to sit for extended periods, talk on the telephone, and type on a computer • Ability to multitask, prioritize, and adapt to a fast-paced changing environment • Proficiency navigating multiple computer systems and keyboarding • Effective verbal and written communication skills • 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 tools • Ability to log in to secure systems such as VPN and EHR portals, follow computer security practices, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently

🏖️ 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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