Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 2 hours ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $26 - $56 / 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.

Apply Now

Find Similar Remote Jobs

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 established guidelines, policies, and clinical judgment to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services and benefits 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 and resources that support their healthcare needs • Serve as a clinical resource for internal and external stakeholders • Work within a 24/7 Utilization Management operation • Collaborate frequently with providers, members, and interdisciplinary healthcare teams • Meet productivity and quality expectations in a remote, computer-based position • Work schedules that may include evenings, weekends, and holidays

🎯 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 decision-making skills • Excellent verbal and written 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 Eastern 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 virtual work location compliant with CVS Health and HIPAA guidelines • Ability to 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 navigate multiple 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 security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot 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 • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work from home • Opportunities to expand knowledge of Utilization Management and Managed Care

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume