Utilization Management Nurse Consultant

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $32 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 20%

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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Lifelancer

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2020

💼 Consulting

🏥 Healthcare

📦 Logistics

💰 Pre Seed Round on 2022-03

Consulting • Healthcare • Logistics

Lifelancer is an AI-powered talent hiring platform that connects employers with skilled professionals in the Life Sciences, Pharmaceutical, and IT sectors. It enables individuals to create profiles showcasing their skills, get matched with high-paying international jobs or projects, and facilitates hiring and payroll for employers in multiple countries. The platform aims to streamline the hiring process with efficient AI sourcing and compliance support.

📋 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 quality and effective healthcare services and benefit utilization • Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Work within a 24/7 utilization management operation, including possible weekends, holidays and evening hours • Perform work involving prolonged sitting, telephone communication, computer use and close inspection of documents and monitors • Navigate multiple applications and systems while meeting productivity and quality expectations

🎯 Requirements

• 2+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care • Active, current and unrestricted RN licensure in state of residence • Associate or Bachelor of Science in Nursing (BSN preferred) • Preferred: 3+ years of clinical experience in adult med surg or specialty area • Managed Care experience preferred, especially Utilization Management • Preference for candidates residing in the CST zone • Direct/hardwired internet connection to modem/router within 7 feet of 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 • Ability to work within the state and city where currently residing • Proficiency navigating multiple systems and keyboarding • Effective verbal and written communication skills • Experience or ability to use Microsoft Office 365 or similar productivity applications • Ability to use secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues and contact IT when necessary • Openness to learning new workplace skills

🏖️ Benefits

• 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.) • CVS Health bonus, commission or short-term incentive program in addition to base pay • Flexible work-from-home arrangement