Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 59 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $26 - $74 / 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.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 criteria to make utilization and coverage recommendations • Collaborate with providers and healthcare teams to support appropriate treatment plans and care coordination • Identify opportunities to improve healthcare quality, outcomes, and benefit utilization • Refer members to additional programs and services supporting their healthcare needs • Serve as a clinical resource for internal and external stakeholders • Work evenings, weekends, and holidays as schedules may include them in a 24/7 operation

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in an adult acute care or critical care setting • Strong communication, critical thinking, and multitasking skills • Proficiency navigating multiple computer systems • Associates Degree in Nursing Required • 2+ years of Med-Surg or specialty clinical experience (preferred) • Managed Care and/or Utilization Management experience (preferred) • Candidates residing in the Central or Eastern time zones (preferred) • BSN Preferred • 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 and private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Must provide own workspace furniture, such as a desk or standing desk • Comfortable setting up and 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 applications or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently and contact IT for unresolved issues • 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 • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.)

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