Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 28 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.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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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 support coverage determinations • Collaborate with providers and interdisciplinary teams to coordinate care and optimize outcomes • Identify opportunities to improve healthcare quality, efficiency, and member experience • Connect members with additional programs and services when appropriate • Serve as a clinical resource for utilization and benefit management activities • Work in a fast-paced, team-oriented remote environment with productivity and quality goals • Participate in a 24/7 operation requiring evenings, weekends, and holidays

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in adult acute care or critical care • Associate Degree in Nursing (ADN) • Strong clinical judgment, communication, and computer skills • Experience in Medical-Surgical or specialty nursing • Utilization Management or Managed Care experience • Candidates located in the Eastern or Central Time Zone • 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 use multiple monitors and multiple applications simultaneously • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to access 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 • 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 including keyboard, monitor, computer, and headset • Fully remote work environment • Schedule flexibility, including evenings, weekends, and holidays

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