Utilization Management Nurse Consultant – Weekends

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🍑 Georgia – Remote

🍑 Georgia – Remote

💵 $26 - $68 / 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

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply appropriate 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 integrating other products, services and programs • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization • Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work within a 24/7 utilization management operation, including holidays and evening hours

🎯 Requirements

• 3+ years of experience as a Registered Nurse • Active, current and unrestricted RN licensure in state of residence • 1+ years of Med/Surg experience • 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) • Willingness and ability to work Saturday, Sunday, Monday and Tuesday 10-hour shifts after approximately 4–5 months of training • Willingness to work occasional holiday rotations • Associates degree required • Prior Authorization or Utilization Management experience preferred • Managed care experience preferred • Experience using MedCompass preferred • Ambulatory surgery experience preferred • Medicare experience is a must

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility • CVS Health bonus, commission or short-term incentive program in addition to base pay

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