Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $29 - $68 / 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 evidence-based criteria to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care • Collaborate with providers and care teams to facilitate appropriate treatment plans • Identify opportunities to improve quality, efficiency, and healthcare utilization • Connect members to additional programs and services as appropriate • Serve as a clinical resource for internal and external stakeholders • Work in a remote, non-bedside utilization management role • Work afternoon/evening shifts within a 24/7 operation • Work 40 hours per week

🎯 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 and decision-making skills • Ability to navigate multiple computer systems and manage competing priorities • Excellent verbal and written communication skills • Associate Degree in Nursing required • Willingness to work weekends, holidays, and evening shifts • 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 • 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 screen locking, strong passwords, and suspicious-link recognition • Ability to troubleshoot common technical issues and contact IT when needed • Openness to learning new skills • Preferred: 2+ years of Med-Surg or specialty nursing experience • Preferred: Managed Care experience, particularly Utilization Management • Preferred: Residence in the Eastern Time Zone • 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 (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program eligibility

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