Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 8 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.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

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review and assess clinical information to support coverage determinations and care recommendations • Apply clinical guidelines, policies, and professional judgment to utilization management decisions • Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans • Identify opportunities for care management referrals and enhanced member support services • Promote quality outcomes, effective healthcare utilization, and member-centered care • Serve as a clinical resource for internal and external stakeholders • Work a 24/7 operation schedule including evenings, weekends, and holidays • Work from a designated home workspace and comply with work-from-home, security, and HIPAA requirements • Set up and use multiple monitors and applications • Communicate via email, calendar invites, Teams, and virtual meetings • Troubleshoot common technical issues and contact IT for unresolved issues

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in adult acute care or critical care settings • Associate Degree in Nursing (ADN) • Strong communication, critical thinking, and multitasking skills • Proficiency navigating multiple computer systems in a high-volume environment • 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 virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Ability to use multiple monitors and navigate multiple applications simultaneously • Ability to communicate through 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 and password security practices and recognize suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace environment evolves • Preferred: 2+ years of Med-Surg or specialty clinical experience • Preferred: Utilization Management or Managed Care experience • BSN preferred • Candidates located in Eastern or Central Time Zones preferred • Qualified applicants with arrest or conviction records will be considered in accordance with applicable federal, state, and local laws

🏖️ 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.)