Utilization Management Nurse Consultant

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🌐 United States, Canada, +1 more countries – Remote

🇺🇸 United States – Remote 🇨🇦 Canada – Remote 🇮🇪 Ireland – Remote

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 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 cases and make coverage determinations using evidence-based criteria • Collaborate with providers and interdisciplinary care teams to support treatment planning • Apply clinical judgment to utilization management and prior authorization decisions • Identify opportunities to improve quality, outcomes, and member experience • Serve as a trusted clinical resource for internal and external stakeholders • Work Monday-Friday, 9:00 AM-5:30 PM in the local time zone • Support a 24/7 utilization management operation, with schedules potentially including evenings, weekends, and holidays

🎯 Requirements

• Active, unrestricted RN license in the state of residence • Minimum 3 years of RN experience • Strong clinical assessment, critical thinking, and decision-making skills • Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel • Associate Degree in Nursing (ADN) • Ability to work Monday-Friday, 9:00 AM-5:30 PM in your local time zone • Schedules may include occasional evenings, weekends, and holidays based on business needs • Direct wired internet connection with minimum 25 Mbps download / 3 Mbps upload; Wi-Fi and satellite internet are not permitted • Dedicated, private workspace complying with HIPAA and company security requirements • Ability to work from confirmed state and city of residence • Commitment to maintaining required internet speeds and remote work standards • Ability to navigate multiple monitors and applications simultaneously • Comfort using Teams, Outlook, email, calendars, and virtual meeting platforms • Experience with Microsoft 365 applications or similar tools • Ability to securely access systems, including VPNs and healthcare applications • Basic troubleshooting skills, including resolving connectivity and application issues • Willingness to learn new technology and adapt to evolving business needs

🏖️ Benefits

• Company-provided equipment includes computer, monitor(s), keyboard, and headset • Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to the base pay range

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