Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 12 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 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

• Review clinical cases and make coverage determinations using evidence-based guidelines • Collaborate with providers and care teams to coordinate appropriate treatment • Apply clinical judgment to support utilization and benefit management decisions • Identify opportunities to improve care quality and member outcomes • Serve as a clinical resource across internal and external stakeholders • Transition clinical skills into a collaborative, non-bedside role • Work Monday–Friday with schedules that may include holidays and evening hours • Use multiple monitors and applications to streamline tasks and improve efficiency • Communicate through email, calendar invites, Teams messaging, and virtual meetings • Access secure systems including VPN and EHR portals • Troubleshoot common technical issues and contact IT for unresolved issues • Learn new skills as the workplace environment evolves

🎯 Requirements

• Active, unrestricted RN license in the state of residence • 3+ years of RN experience, including 1+ year in Med/Surg • Strong clinical assessment and decision-making skills • Experience with Microsoft Office (Outlook, Teams, Excel) • Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone • Work schedules may include holidays and evening hours because Utilization Management is a 24/7 operation • Associate Degree in Nursing • Ability to work remotely from the state and city where currently residing • 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 workspace compliant with CVS Health and HIPAA guidelines • Ability to use multiple monitors and navigate multiple applications simultaneously • 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 lock computer screens, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently and contact IT when needed • Nice to have: Utilization Management or Prior Authorization experience • Nice to have: Managed care background • Nice to have: Familiarity with MedCompass • Nice to have: Ambulatory surgery experience • BSN 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.) • Supportive, team-driven work environment

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