Utilization Management Nurse Consultant – Weekends, 4-10 Hour Shifts

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🐊 Florida, Idaho, +3 more states – Remote

🐊 Florida – Remote 🥔 Idaho – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote 🤠 Texas – Remote

💵 $26 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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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

• 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 effective benefit utilization • Consult and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work Friday, Saturday, Sunday and Monday 10-hour shifts after approximately 4–5 months of training • Complete training Monday–Friday, 8:30 a.m.–5:00 p.m. EST, with occasional holiday rotation

🎯 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, including Outlook, Teams and Excel • Willingness and ability to work Friday, Saturday, Sunday and Monday 10-hour shifts after approximately 4–5 months of training • Prior Authorization or Utilization Management experience preferred • Managed care experience preferred • Experience using MedCompass preferred • Ambulatory surgery experience preferred • Associate’s degree required • BSN preferred • Direct/hardwired internet connection to a modem/router within 7 feet of the computer, or ability to obtain one • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently living • Ability to set up and use multiple monitors and navigate multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to log in to secure systems such as VPN and EHR portals, lock the computer when unattended, manage strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues and contact IT for unresolved issues • Openness to learning new workplace 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 physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work from a designated home workspace