Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 12 hours ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $26 - $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.

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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

• Apply critical thinking, evidence-based clinical criteria and clinical practice guidelines to services requiring precertification • Collect and review clinical information from providers by phone and computer • Use specific criteria to authorize procedures and services • Initiate Medical Director referrals when needed • Perform sedentary desk-based work involving sitting, talking, listening and computer use • Navigate multiple systems, monitors and applications to streamline tasks • Communicate through email, calendar invites, Teams and virtual meetings • Access secure systems and maintain computer and information security • Troubleshoot common technical issues and contact IT for unresolved issues

🎯 Requirements

• Active, current and unrestricted RN licensure in state of residence • At least an Associate’s Degree • 3+ years of clinical experience in nursing • Willingness and ability to work Monday–Friday, 8 am–5 pm, with occasional weekend/holiday on-call or rotating 10-hour shifts • Proficient computer skills, including navigating multiple systems • Ability to work in a fast-paced environment • 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 and private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Ability to use multiple monitors and applications simultaneously • Ability to use 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 • Knowledge of computer security practices, including strong passwords and recognizing suspicious emails or links • Ability to troubleshoot common technical issues and contact IT when needed • Openness to learning new skills • Previous prior authorization experience preferred • Compact RN licensure preferred • BSN preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Telework/work-from-home arrangement