Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 2 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – 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.

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 clinical information and authorize services based on established criteria and guidelines • Assess medical necessity and appropriate benefit utilization • Coordinate care and support safe, efficient discharge planning • Communicate with providers and healthcare teams to facilitate treatment plans • Identify opportunities for care management and quality improvement • Document and manage utilization review activities throughout the continuum of care • Work collaboratively with providers, facilities, and internal partners to ensure quality outcomes and regulatory compliance • Work Monday-Friday, generally 8:00 AM-5:00 PM CST • Participate in occasional weekend on-call coverage • Work remotely from an Oklahoma home office with no travel required

🎯 Requirements

• Must reside in Oklahoma • Active, unrestricted RN license in Oklahoma • Minimum 2 years of acute care hospital RN experience • Associate Degree in Nursing • 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 work location compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently living • Must provide own workspace furniture • Comfortable setting up and using multiple monitors and navigating multiple applications • 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 follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace evolves • BSN preferred • Utilization Review and/or Utilization Management experience preferred • Managed Care experience preferred • Strong communication and critical-thinking skills preferred • Proficiency with Microsoft Office and computer-based systems preferred • Ability to manage multiple priorities in a fast-paced environment preferred

🏖️ 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.)