Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $26 - $56 / 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 documentation and apply evidence-based criteria, policies, and clinical judgment to support coverage determinations • Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care • Collaborate with providers and care teams to facilitate appropriate treatment plans and care coordination • Identify opportunities to improve healthcare quality, effectiveness, and benefit utilization • Connect members to programs and resources supporting positive health outcomes • Serve as a clinical resource and consultant to internal and external stakeholders • Work in a computer-based 24/7 utilization management operation • Collaborate frequently with providers, members, and interdisciplinary teams

🎯 Requirements

• Active, unrestricted RN license in your state of residence • 2+ years of adult acute care and/or critical care nursing experience • Strong clinical assessment, critical thinking, and communication skills • Ability to manage multiple priorities in a fast-paced, technology-driven environment • Proficiency navigating multiple computer systems • Associate Degree in Nursing required • 2+ years of Med-Surg or specialty nursing experience preferred • Managed Care or Utilization Management experience preferred • Residence in the North Central Time Zone preferred • BSN preferred • Ability to work evenings, weekends, and holidays as schedules may require • 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 • Must work within the state and city where currently living • Microsoft Office 365 applications or similar Google Workspace experience • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Ability to access secure systems such as VPN and EHR portals • Ability to 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, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Remote work from home • Company-provided equipment including keyboard, monitor, computer, and headset