Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut, Florida, +19 more states – Remote

🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Assess, plan, implement, coordinate, monitor, and evaluate healthcare service and benefit options • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment • Render coverage determinations or recommendations across the continuum of care • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities to other products, services, and programs • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with and provide expertise to internal and external constituents • Coordinate and administer utilization and benefit management functions • Work a permanent Monday-Friday schedule from 8 a.m. to 5 p.m. EST • Support a 24/7 utilization management operation, which may include weekends, holidays, and evening hours

🎯 Requirements

• 3+ years of experience as an acute care RN • Active and unrestricted RN licensure in state of residence • Able to work in multiple IT platforms/systems • 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel) • Associates Degree in Nursing required • 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 • WiFi and satellite internet are not permitted • Quiet, secure, private designated home 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 • 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 information security • Ability to troubleshoot common technical issues • Must be willing to obtain required internet speeds and follow Work From Home requirements

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • 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