Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

🦀 Maryland – Remote

🦀 Maryland – Remote

💵 $32 - $68 / 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

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

Upload Resume

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 and assess clinical information to support utilization and coverage determinations • Collaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plans • Identify opportunities for care management referrals and member support programs • Promote quality, cost-effective healthcare outcomes • Serve as a clinical resource for utilization and benefit management activities • Communicate with providers and apply evidence-based criteria and clinical judgment • Support effective, high-quality healthcare services for members • Work in a remote/office-based environment with extensive computer and telephone use • Navigate multiple systems and multitask in a sedentary desk-based role

🎯 Requirements

• Active, unrestricted RN license in state of residence • 2+ years of RN experience in adult acute care or critical care settings • Strong clinical assessment, communication, and computer skills • Ability to thrive in a fast-paced, highly collaborative environment • Associates Degree in Nursing • Preferred: 2+ years of Med-Surg or specialty clinical experience • Preferred: Managed Care and/or Utilization Management experience • Preferred: Candidates residing in Eastern time zones • Preferred: BSN • Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 mbs download and 3 mbs upload • WiFi and satellite internet are not permitted • 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 navigate multiple monitors and applications simultaneously • Ability to use digital communication channels including email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to log in to secure systems such as VPN and EHR portals • Ability to lock computer screens, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • 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 • Company-provided equipment (keyboard, monitor, computer, headset, etc.)