Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 9 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – 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 evidence-based criteria to make coverage and authorization determinations • Collaborate with physicians, providers, and interdisciplinary teams to support quality patient outcomes • Identify opportunities for care coordination, case management, and other healthcare programs • Promote effective healthcare utilization and member-centered care • Serve as a clinical resource and partner for internal and external stakeholders • Work within a 24/7 Utilization Management operation • Document work using multiple systems and documentation platforms • Support patient advocacy, critical thinking, healthcare decision-making, and improved member experiences

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of Registered Nurse experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • 2+ years of Med-Surg or specialty clinical experience preferred • Utilization Management or Managed Care experience preferred • BSN preferred • Candidates located in the Eastern Time Zone are strongly preferred • Ability to work evenings, weekends, and holidays as schedules may vary in a 24/7 operation • Strong multitasking and communication skills • Computer-based work requiring navigation of multiple systems and documentation platforms • Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds 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 • Ability to use multiple monitors and navigate multiple applications • Ability to communicate through 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, secure devices, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently and contact IT when needed • Openness to learning new skills as the workplace evolves

🏖️ 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 including keyboard, monitor, computer, and headset

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