Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 minute ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 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

• 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 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 and effective benefit utilization • Consult with and provide expertise to internal and external constituents regarding utilization and benefit management • Work in a typical office environment with productivity and quality expectations • Perform close inspection of handwritten and computer-generated documents and PC monitor • Sit for extended periods, talk on the telephone and type on a computer • Multitask, prioritize and adapt to a fast-paced changing environment

🎯 Requirements

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Active, current and unrestricted RN licensure in state of residence • Associates Degree required • 2+ years of clinical experience in med surg or specialty area • Experience with Microsoft Office 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications • Ability to navigate multiple monitors and applications simultaneously • Ability to use email, calendar invites, Teams messaging and virtual meetings • Ability to log in to secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues • Direct/hardwired internet connection within 7 feet of modem/router • Minimum internet speed of 50 Mbps download and 5 Mbps upload • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Effective verbal and written communication skills • Ability to work weekends, holidays and evening hours in a 24/7 operation • Ability to work within the state and city where currently living

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work from home

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