Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 18 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – 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 recommendations • Collaborate with providers and interdisciplinary teams to support care coordination • Identify opportunities to improve quality, outcomes, and healthcare resource utilization • Refer members to appropriate programs and services that support their healthcare needs • Serve as a clinical resource for internal and external stakeholders • Support a 24/7 Utilization Management team • Help ensure members receive the right care at the right time

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of RN experience in an adult acute care or critical care setting • Associate Degree in Nursing (ADN) • Strong communication, multitasking, and computer skills • Ability to work a flexible schedule, including evenings, weekends, and holidays • 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 • 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 living • Ability to use multiple monitors and navigate 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 maintain computer security, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • BSN preferred • 2+ years of Med-Surg or specialty clinical experience preferred • Utilization Management and/or Managed Care experience preferred • Eastern Time Zone candidates 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.) • Opportunity for professional growth and learning new skills

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