Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 13 hours ago

🌪️ Kansas – Remote

🌪️ Kansas – Remote

💵 $26 - $56 / 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 clinical information and apply evidence-based guidelines, policies, and clinical judgment to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care • Collaborate with providers and care teams to facilitate appropriate treatment and care planning • Identify opportunities to improve quality of care, member outcomes, and healthcare utilization • Connect members with additional programs, services, and resources when appropriate • Serve as a clinical resource for internal and external stakeholders • Work remotely in a computer-based role with productivity and quality expectations • Collaborate frequently with providers, members, and interdisciplinary healthcare teams • Work schedules that may include evenings, weekends, and holidays because Utilization Management operates 24/7

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of adult acute care and/or critical care nursing experience • Strong clinical assessment, critical thinking, and communication skills • Ability to multitask and work effectively in a fast-paced environment • Proficiency navigating multiple computer systems and applications • Associate Degree in Nursing required • 2+ years of Med-Surg or specialty nursing experience preferred • Managed Care or Utilization Management experience preferred • Residence in the Central Time Zone preferred • BSN preferred • 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 • 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 provide workspace furniture, such as a desk or standing desk • Ability to use multiple monitors and applications simultaneously • Ability to communicate via 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, password, and security practices • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace environment 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 colleagues’ and families’ physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work from home • Collaborative clinical team environment • Career growth in Utilization Management and Managed Care