Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 48 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.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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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 • Collaborate with providers and interdisciplinary teams to coordinate care and optimize outcomes • Identify opportunities to improve healthcare quality, efficiency, and member experience • Connect members with additional programs and services when appropriate • Serve as a clinical resource for utilization and benefit management activities • Work in a fast-paced, team-oriented remote setting with productivity and quality goals • Work a flexible schedule including evenings, weekends, and holidays as part of a 24/7 operation

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in adult acute care or critical care • Associate Degree in Nursing (ADN) • Candidates located in the Eastern or Central Time Zone • Strong clinical judgment, communication, and computer skills • Experience in Medical-Surgical or specialty nursing • Utilization Management or Managed Care experience • 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 virtual work location compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently living • Ability to provide workspace furniture • Ability to use multiple monitors and navigate multiple applications • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ 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 in addition to base pay • Flexible scheduling, including evenings, weekends, and holidays as part of a 24/7 operation

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