Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

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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 make coverage recommendations • Collaborate with healthcare providers and internal teams to support quality patient outcomes • Identify opportunities for care coordination and member support programs • Promote effective healthcare utilization and contribute to high-quality service delivery • Manage multiple systems and priorities in a fast-paced, team-oriented environment • Support members in navigating their healthcare journey • Work scheduled shifts that may include evenings, weekends, and holidays as part of a 24/7 operation

🎯 Requirements

• Active, unrestricted RN license in your state of residence • Minimum 2 years of RN experience in an adult acute care or critical care setting • Associate's Degree in Nursing • Strong communication, computer, and multitasking skills • Ability to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation • Previous Managed Care and/or Utilization Management experience preferred • 2+ years of clinical experience in Medical-Surgical or specialty care preferred • BSN preferred • Candidates located in Central Time Zone preferred • 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 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 • Experience with Microsoft Office 365 applications or similar tools such as Google Workspace • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer and password security practices and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently

🏖️ 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.)