Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 3 hours ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $29 - $62 / 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 other products, services, and programs • Identify opportunities to promote healthcare service quality, effectiveness, and benefit utilization • Consult with and provide expertise to internal and external constituents in utilization and benefit management • Work in a typical office environment with productivity and quality expectations • Inspect handwritten and computer-generated documents and PC monitor content • Perform sedentary work involving extended sitting, telephone conversations, listening, and computer typing • Multitask, prioritize, and adapt effectively to a fast-paced changing environment

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in adult acute care or critical care settings • Strong clinical assessment, communication, and multitasking skills • Comfortable working in a fast-paced, technology-driven environment • Associate Degree in Nursing required • 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 workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Proficiency navigating multiple systems and applications • Ability to use digital communication tools, virtual meetings, and Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, including strong password management and recognizing suspicious emails or links • Ability to troubleshoot common technical issues • Flexibility to work evenings, weekends, and holidays in a 24/7 operation • Preferred: 2+ years of Med-Surg or specialty clinical experience • Preferred: Managed Care and/or Utilization Management experience • BSN preferred

🏖️ 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, including keyboard, monitor, computer, and headset • CVS Health bonus, commission or short-term incentive program eligibility in addition to base pay

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