Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 12 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – 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 recommendations • Collaborate with providers and interdisciplinary teams to support care coordination • Identify opportunities to improve quality, outcomes, and healthcare resource utilization • Refer members to appropriate programs and services supporting their healthcare needs • Serve as a clinical resource for internal and external stakeholders • Support the 24/7 Utilization Management team • Assess medical necessity and coordinate care • Use clinical judgment to optimize healthcare outcomes

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • Strong communication, multitasking, and computer skills • Ability to work a flexible schedule, including evenings, weekends, and holidays • Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 mbs download and 3 mbs upload • WiFi and satellite internet are not permitted • 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 set up and use multiple monitors and navigate multiple applications • Ability to communicate via 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 locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently and contact IT for unresolved issues • Preferred: 2+ years of Med-Surg or specialty clinical experience • Preferred: Utilization Management and/or Managed Care experience • BSN preferred • Eastern Time Zone candidates preferred

🏖️ 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 (keyboard, monitor, computer, headset, etc.) • Opportunity to make a direct impact on member care and outcomes • Collaborative, mission-driven healthcare environment

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