Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 11 minutes ago

🌵 Arizona, California, +18 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🧀 Wisconsin – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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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 cases and make coverage determinations using evidence-based guidelines • Collaborate with providers and care teams to coordinate appropriate treatment • Apply clinical judgment to support utilization and benefit management decisions • Identify opportunities to improve care quality and member outcomes • Serve as a clinical resource across internal and external stakeholders • Use clinical expertise to support members receiving the right care at the right time • Work in a remote, non-bedside utilization management role • Coordinate care and support healthcare quality

🎯 Requirements

• Active, unrestricted RN license in the state of residence • 3+ years of RN experience, including 1+ year in Med/Surg • Strong clinical assessment and decision-making skills • Experience with Microsoft Office (Outlook, Teams, Excel) • Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone; schedules may include holidays and evening hours • Associate Degree in Nursing • 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 • Ability to use multiple monitors and navigate multiple applications • 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 maintain computer and password security and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Must obtain required internet speeds and adhere to Work From Home requirements if hired • Utilization Management or Prior Authorization experience preferred • Managed care background preferred • Familiarity with MedCompass preferred • Ambulatory surgery experience preferred • BSN 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.) • Remote work from home