Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 6 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $29 - $62 / 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

• 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 integrating other products, services and programs • Identify opportunities to promote healthcare service quality and benefit utilization • Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work in a 24/7 utilization management operation with weekend, holiday and evening schedules • Perform computer-based administrative work involving multiple systems, telephone communication, typing and document inspection

🎯 Requirements

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Active, current and unrestricted RN licensure in the state of residence • Associates Degree required • 2+ years of clinical experience in med surg or a specialty area • Managed Care experience preferred, especially Utilization Management • Preference for candidates residing in PST zones • Proficiency with computer skills, including navigating multiple systems and keyboarding • Effective verbal and written communication skills • Ability to work weekends, holidays, and evening hours in a 24/7 operation • Ability to obtain a direct/hardwired internet connection with minimum speeds of 50 Mbps download and 5 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 provide workspace furniture • Ability to use Microsoft Office 365 or similar Google Workspace applications • Ability to use secure systems such as VPN and EHR portals • 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 work equipment (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program eligibility

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