Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 hour 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 coverage and authorization determinations • Collaborate with physicians, providers, and interdisciplinary teams to support quality patient outcomes • Identify opportunities for care coordination, case management, and other healthcare programs • Promote effective healthcare utilization and member-centered care • Serve as a clinical resource and partner for internal and external stakeholders • Work in a computer-based role using multiple systems and documentation platforms • Support patient advocacy, critical thinking, healthcare decision-making, healthcare quality, outcomes, and member experiences

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of Registered Nurse experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • Candidates located in the Eastern Time Zone are strongly preferred • 2+ years of Med-Surg or specialty clinical experience preferred • Utilization Management or Managed Care experience preferred • BSN 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 evenings, weekends, and holidays as schedules may vary in a 24/7 operation • Ability to navigate multiple monitors, applications, systems, and documentation platforms • Ability to use 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 environment evolves • Must work within the state and city where currently residing

🏖️ 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.) • Comprehensive benefits package supporting physical, emotional, and financial well-being

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