Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 minute ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $26 - $74 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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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 clinical information and apply evidence-based criteria to coverage determinations • Collaborate with providers, care teams, and internal partners to support quality patient care • Identify opportunities for care coordination and program referrals • Promote effective healthcare utilization and positive member outcomes • Document decisions and navigate multiple systems while meeting productivity and quality goals • Work within a 24/7 Utilization Management operation • Support members in receiving the right care at the right time

🎯 Requirements

• Active, unrestricted RN license in your state of residence • Minimum 2 years of RN experience in adult acute care, critical care, med-surg, or a specialty area • Associate Degree in Nursing • Utilization Management or Managed Care experience preferred • BSN preferred • Strong clinical assessment, communication, and critical thinking skills • Ability to multitask and thrive in a technology-driven environment • Availability for schedules that may include evenings, weekends, and holidays • 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 • WiFi and satellite internet are not permitted • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Experience setting up and using multiple monitors and navigating multiple applications simultaneously • Ability to use 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 security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently and contact IT for unresolved issues • Openness to learning new skills as the workplace evolves

🏖️ 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 • Remote work opportunity • Company-provided equipment, including keyboard, monitor, computer, and headset

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