Utilization Management Nurse Consultant- Specialty Medications Job at CVS Health (Columbus)

Case Manager, Registered Nurse

Remote case manager position working intensely as a telephonic case manager with...

Location

United States , Remote

Salary:

54095.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

5+ years’ experience as a Registered Nurse
1+ year of experience in a hospital setting
Active, unrestricted RN license in state of residence
Willingness to receive multi-state/compact privileges
1+ years' experience documenting electronically using a keyboard
1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics experience

Job Responsibility

Work as a telephonic case manager with patients and their care team
Application and/or interpretation of applicable criteria and clinical guidelines
Assess benefits and/or member's needs to ensure appropriate administration of benefits
Incorporate strategies designed to reduce risk factors and barriers
Address complex health and social indicators which impact care planning
Consult with supervisor and others in overcoming barriers
Utilize case management processes in compliance with regulatory requirements
Utilize motivational interviewing skills for member engagement
Identify and escalate member's needs appropriately
Actively reach out to members to collaborate/guide their care

What we offer

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules

Fulltime

New

Utilization Management Nurse Consultant

We're building a world of health around every individual — shaping a more connec...

Location

United States , Work At Home, Columbus, Ohio

Salary:

29.10 - 62.32 USD / Hour

CVS Health

Expiration Date

Until further notice

Requirements

Active unrestricted state Registered Nurse licensure in state of residence required
Minimum 5 years of relevant experience in Nursing
At least 1 year of Utilization Management experience in concurrent review or prior authorization
Strong decision-making skills and clinical judgment in independent scenarios
Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation

Job Responsibility

Apply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review
Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information
Use established guidelines to authorize services or escalate to Medical Directors as needed
Navigate multiple computer systems efficiently while maintaining accurate documentation
Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills
Perform sedentary work that primarily involves extended periods of sitting, as well as frequent talking, listening, and use of a computer
Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support
Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs

Fulltime

Director of care management services inpatient

UNM Health provides the highest quality of care for more than 200,000 New Mexica...

Location

United States , Albuquerque

Salary:

53.29 - 82.51 USD / Hour

UNM Hospitals

Expiration Date

Until further notice

Requirements

Master's Degree in Health Related Discipline
4 years directly related experience
New Mexico RN or Social Work license

Job Responsibility

Coordinate the planning, implementation and evaluation of the inpatient care management and case management programs
Responsible for the ongoing development of care management implementation strategies
monitoring and evaluation of project outcomes
effectively communicating and integrating the mission, values and strategic initiatives of the hospitals and the Health Sciences Center
Ensure adherence to Hospitals and departmental policies and procedures
Patient care assignment may include neonate, pediatric, adolescent, adult, and geriatric age groups
Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable
Participate in the assessment, development, implementation, evaluation, and attendance of educational needs for personnel based on quality assurance indicators
Assist in the development of a care delivery system consistent with changes in patient needs, medical technology and the professions involved with specific case types
Maintain awareness of ongoing Quality Assurance studies within the unit

What we offer

Relocation Assistance Available

Fulltime

Short Hour Coordinator Hospital Operations (Bed Control)

Oversees hospital administrative daily operations. Ensures accessible, appropria...

Location

United States , Honolulu

Salary:

64.66 - 83.66 USD / Hour

Kaiser Permanente

Expiration Date

Until further notice

Requirements

Minimum two (2) years of acute care experience, including experience or successful completion of training program (pre-hire, post-hire, or on-the-job) in area of specialty, if applicable
Bachelors degree in nursing or RN with three (3) years nursing leadership and/or charge nurse experience
Registered Nurse License (Hawaii) required at hire
Basic Life Support from American Heart Association
Advanced Cardiac Life Support from American Heart Association
Demonstrated knowledge of and skill in decision making, customer service, interpersonal relations, oral communication, problem solving, quality management, and written communication

Job Responsibility

Oversees hospital administrative daily operations
Ensures accessible, appropriate, patient-focused, and cost-effective services
Collaborates with administrative and medical teams to ensure timely, quality care, and safe hospital operations
Develops, implements, and monitors policies and procedures to support organizational goals and business objectives
Evaluates process to improve systems across continuum
Identifies and implements strategies to reduce costs and improve quality of care/services
Serves as role model
Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff
Ensures staff completes mandatory education and clinical competencies as per policy
Provides nursing consultation to unit staff, peers, and other hospital personnel

Family Physician

The Family Medicine Physician delivers quality primary medical care in an effici...

Location

United States , Bear

Salary:

Not provided

Westside Family Healthcare Inc

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of medicine
Completion of an appropriate accredited medical residency program
Licensure to practice medicine in Delaware
Basic life support certification
Ability to travel between worksites as needed
Certification or eligibility for certification by an applicable American Medical Specialty Board
Eligibility for staff privileges to local hospitals associate with WFH
Full-time experience in the practice of medicine in direct primary patient care, both outpatient and inpatient

Job Responsibility

Provide primary medical care to patients, including collecting and recording patient information in the EMR in a thorough and timely manner
prescribing or administering treatment
ordering, performing, and interpreting tests and analyzing records, reports, and examination information to diagnose patients' conditions
monitoring patients' conditions and progress and reevaluating treatments as necessary
explaining procedures and discussing test results or prescribed treatments with patients
advising patients concerning diet, activity, hygiene, and disease prevention
referring patients to medical specialists or other practitioners when necessary
and participating in hospital admission and follow-up of patients, making arrangement for services as needed
Coordinate work with other members of the care team, including nurses, social workers, rehabilitation therapists, pharmacists, psychologists, and other health care providers
Provide emergency medical treatment to WFH patients as needed, and provide emergency medical treatment as requested or appropriate to non-WFH patients who are at or near a location where the physician is present for the purpose of providing services to WFH patients

What we offer

$20,000 SIGN ON BONUS

Fulltime

Family Physician

The Family Medicine Physician delivers quality primary medical care in an effici...

Location

United States , Dover

Salary:

Not provided

Westside Family Healthcare Inc

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of medicine
Completion of an appropriate accredited medical residency program
Licensure to practice medicine in Delaware
Basic life support certification
Ability to travel between worksites as needed
Certification or eligibility for certification by an applicable American Medical Specialty Board
Eligibility for staff privileges to local hospitals associate with WFH
Full-time experience in the practice of medicine in direct primary patient care, both outpatient and inpatient

Job Responsibility

Provide primary medical care to patients, including collecting and recording patient information in the EMR in a thorough and timely manner
prescribing or administering treatment
ordering, performing, and interpreting tests and analyzing records, reports, and examination information to diagnose patients' conditions
monitoring patients' conditions and progress and reevaluating treatments as necessary
explaining procedures and discussing test results or prescribed treatments with patients
advising patients concerning diet, activity, hygiene, and disease prevention
referring patients to medical specialists or other practitioners when necessary
and participating in hospital admission and follow-up of patients, making arrangement for services as needed
Coordinate work with other members of the care team, including nurses, social workers, rehabilitation therapists, pharmacists, psychologists, and other health care providers
Provide emergency medical treatment to WFH patients as needed, and provide emergency medical treatment as requested or appropriate to non-WFH patients who are at or near a location where the physician is present for the purpose of providing services to WFH patients

Fulltime

Family Physician

Westside Family Healthcare is a nonprofit organization that provides high qualit...

Location

United States , Newark

Salary:

Not provided

Westside Family Healthcare Inc

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of medicine
Completion of an appropriate accredited medical residency program
Licensure to practice medicine in Delaware
Basic life support certification
Ability to travel between worksites as needed
Certification or eligibility for certification by an applicable American Medical Specialty Board
Eligibility for staff privileges to local hospitals associate with WFH
Full-time experience in the practice of medicine in direct primary patient care, both outpatient and inpatient

Job Responsibility

Provide primary medical care to patients, including collecting and recording patient information in the EMR in a thorough and timely manner
prescribing or administering treatment
ordering, performing, and interpreting tests and analyzing records, reports, and examination information to diagnose patients' conditions
monitoring patients' conditions and progress and reevaluating treatments as necessary
explaining procedures and discussing test results or prescribed treatments with patients
advising patients concerning diet, activity, hygiene, and disease prevention
referring patients to medical specialists or other practitioners when necessary
and participating in hospital admission and follow-up of patients, making arrangement for services as needed
Coordinate work with other members of the care team, including nurses, social workers, rehabilitation therapists, pharmacists, psychologists, and other health care providers
Provide emergency medical treatment to WFH patients as needed, and provide emergency medical treatment as requested or appropriate to non-WFH patients who are at or near a location where the physician is present for the purpose of providing services to WFH patients

What we offer

$20,000 SIGN ON BONUS

Fulltime

Family Physician

The Family Medicine Physician delivers quality primary medical care in an effici...

Location

United States , Wilmington

Salary:

Not provided

Westside Family Healthcare Inc

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of medicine
Completion of an appropriate accredited medical residency program
Licensure to practice medicine in Delaware
Basic life support certification
Ability to travel between worksites as needed
Certification or eligibility for certification by an applicable American Medical Specialty Board
Eligibility for staff privileges to local hospitals associate with WFH
Full-time experience in the practice of medicine in direct primary patient care, both outpatient and inpatient

Job Responsibility

Provide primary medical care to patients, including collecting and recording patient information in the EMR in a thorough and timely manner
prescribing or administering treatment
ordering, performing, and interpreting tests and analyzing records, reports, and examination information to diagnose patients' conditions
monitoring patients' conditions and progress and reevaluating treatments as necessary
explaining procedures and discussing test results or prescribed treatments with patients
advising patients concerning diet, activity, hygiene, and disease prevention
referring patients to medical specialists or other practitioners when necessary
and participating in hospital admission and follow-up of patients, making arrangement for services as needed
Coordinate work with other members of the care team, including nurses, social workers, rehabilitation therapists, pharmacists, psychologists, and other health care providers
Provide emergency medical treatment to WFH patients as needed, and provide emergency medical treatment as requested or appropriate to non-WFH patients who are at or near a location where the physician is present for the purpose of providing services to WFH patients

What we offer

$20,000 SIGN ON BONUS

Fulltime

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Utilization Management Nurse Consultant- Specialty Medications

CVS Health

Location:
United States , Columbus

Category:
Nursing

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
May 15, 2026

Expiration:
May 22, 2026

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Utilization Management Nurse Consultant- Specialty Medications

CVS Health

Location:United States , Columbus

Category:Nursing

Contract Type:Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:May 15, 2026

Expiration:May 22, 2026

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Location:
United States , Columbus

Category:
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Contract Type:
Employment contract

Job Posted:
May 15, 2026

Expiration:
May 22, 2026