Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 hour ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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• Just posted.
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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

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations or recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services and programs • Identify opportunities to promote healthcare service quality, effectiveness and benefit utilization • Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work remotely from the confirmed residential city and state

🎯 Requirements

• 3+ years of experience as a Registered Nurse • Active, current, unrestricted RN licensure in state of residence • 1+ years of Med/Surg experience • 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) • Associate degree required • Prior Authorization or Utilization Management experience preferred • Managed care experience preferred • Experience using MedCompass preferred • Ambulatory surgery experience preferred • Must work Monday through Friday during specified eastern or central time hours, with occasional holiday rotation • Willingness and ability to work evening hours and holidays as part of a 24/7 Utilization Management operation • Direct/hardwired internet connection within 7 feet of computer/router, with minimum 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 • Ability to use digital communication channels and virtual meeting tools • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals and follow security practices • 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 eligibility

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