Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 21 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $29 - $62 / 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 to make coverage recommendations • Coordinate with providers and care teams to support treatment plans and continuity of care • Identify opportunities for care management referrals and improved healthcare utilization • Promote quality, efficiency, and positive member outcomes • Work in a fast-paced, technology-driven environment while meeting productivity and quality goals • Collaborate with providers and healthcare teams as part of a 24/7 operation • Use digital communication channels including email, calendar invites, Teams messaging, and virtual meetings • Log in to secure systems and maintain required system and workspace security • Troubleshoot common technical issues and contact IT for unresolved issues

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in adult acute care, critical care, or medical-surgical • Strong clinical judgment, communication, and multitasking skills • Comfort navigating multiple computer systems, monitors, and Microsoft Office applications • Ability to work independently in a remote environment • Associate degree in nursing required • Utilization Management or Managed Care experience preferred • Prior experience with case management, care coordination, or health plan operations preferred • EST time zone residency 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 workspace compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently residing • Ability to use multiple monitors and applications simultaneously • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to use 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 • Availability for schedules that may include evenings, weekends, and holidays • Ability to work 40 hours per week

🏖️ Benefits

• Fully remote opportunity with company-provided technology equipment • Opportunities for professional growth and development • Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay