Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 17 hours ago

🌪️ Kansas – Remote

🌪️ Kansas – Remote

💵 $26 - $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 physicians, providers, and care teams to coordinate treatment and services • Identify opportunities to improve quality, outcomes, and healthcare resource utilization • Support members through referrals to additional programs and services when appropriate • Contribute to a fast-paced, team-oriented environment focused on delivering exceptional care • Work schedules may include evenings, weekends, and holidays in a 24/7 operation

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of recent RN experience in adult acute care or critical care • Associate Degree in Nursing required • Experience in Medical-Surgical (Med-Surg) nursing or another specialty area preferred • Prior Utilization Management or Managed Care experience preferred • Strong clinical assessment, critical thinking, and communication skills • Ability to navigate multiple computer systems and manage competing priorities • Residence in the Central Time Zone or Mountain 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 • 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 • Must provide own workspace furniture • Comfortable using multiple monitors and navigating multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay range • 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.) • Professional growth opportunities

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