Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 14 hours ago

🌵 Arizona, California, +7 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🥔 Idaho – Remote 🎰 Nevada – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote ❄️ Minnesota – Remote 🎸 Mississippi – 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.Why this score:

• Open for 1 day.
• Jobs at this company usually fill in 21 days.

Apply Now

Find Similar Remote Jobs

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 options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations or recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services and programs • Identify opportunities to promote healthcare service quality and benefit utilization • Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work collaboratively within a 24/7 Utilization Management operation

🎯 Requirements

• 3+ years of experience as a Registered Nurse • Active, current and unrestricted RN licensure in state of residence • 1+ years of Med/Surg experience • 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) • Willingness and ability to work Monday through Friday, 9:00am to 5:30pm eastern or central time, with occasional holiday rotation • Utilization Management schedules may include holidays and evening hours • Prior Authorization or Utilization Management experience preferred • Managed care experience preferred • Experience using MedCompass preferred • Ambulatory surgery experience preferred • Associates degree 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 • Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide workspace furniture • Ability to set up and use multiple monitors and navigate multiple applications • Ability to communicate via email, calendar invites, Teams messaging and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer and password security practices and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills

🏖️ 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 colleagues’ physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.)

📊 Check your resume score for this job

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

Upload Resume