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Cvs Health Utilization Management Remote Jobs in Utah

Pharmacy Careers

Appeals Pharmacist (Remote)

Lehi, UT · On-site +1

$53.75 - $65.50/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... About Us We are a confidential healthcare partner working with health plans and managed care ...

Pharmacy Careers

Appeals Pharmacist (Remote)

South Jordan, UT · On-site +1

$54.25 - $66.25/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... About Us We are a confidential healthcare partner working with health plans and managed care ...

Imh

Social Worker

Murray, UT · Remote

$39.16 - $60.42/hr

... Utilization Management, discharge planning, managed care, health promotion, health coaching ... Experience working successfully g in a remote environment or using Advanced Microsoft Suite ...

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Cvs Health Utilization Management Remote information

What is the difference between Cvs Health Utilization Management Remote vs Cvs Health Medical Reviewer?

AspectCvs Health Utilization Management RemoteCvs Health Medical Reviewer
CredentialsRN, LPN, or other healthcare licensesRN, MD, or DO licenses
Work EnvironmentRemote, home-basedRemote or onsite, depending on role
Employer & Industry UsageUtilization management for insurance approvalsMedical review for claims and authorizations

Both roles involve healthcare assessments, often requiring similar licenses. Utilization Management Remote focuses on reviewing medical necessity for insurance purposes, while Medical Reviewers may handle detailed case evaluations. Both are remote-friendly and integral to healthcare insurance processes, but differ slightly in scope and responsibilities.

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Cvs Health Utilization Management Remote jobs near you

Medical Director - Utilization Management (Remote)

MRIoA

Salt Lake City, UT • On-site, Remote

$240K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Job description

Description
Who We Are - Motivated by Purpose. Powered by Clinical Expertise.
Founded in 1983, we're a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.
Excellence starts with our people.
WE OFFER
  • A competitive compensation package
  • Benefits include healthcare, vision, and dental insurance
  • A generous 401(k) match
  • Paid vacation, PTO, and holidays
  • Growth and training opportunities
  • An award-winning remote work environment

Position Summary
Our Medical Director, also known as a Physician Advisor, is responsible for performing clinical utilization management, peer review activities, and clinical quality management activities.
Key Responsibilities
  • Perform utilization management case reviews.
  • Maintain productivity score per company standard.
  • Maintain annual quality score per company standard.
  • Complete annual inter-rater reliability testing.
  • Train across all queues as requested by MRIoA leadership.
  • Complete all client specific training as requested by MRIoA leadership.
  • Maintain up-to-date records of case completion if required
  • Consistently show willingness to take cases as requested.
  • Demonstrate respect in interactions across the company.
  • Consistently submit scheduling requests at least three months in advance. Consistently work scheduled hours.
  • Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
  • Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team.
  • Actively participate in the MRIoA evaluation process (both company and individual).
  • Participate in all company meetings and committees as requested.
  • Complete other duties as requested or approved by the CEO and/or chief medical officer.
  • Thorough understanding of the Company's clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards

Work Schedule
  • 40 hours per week
  • Five 8-hour shifts or four 10-hour shifts (available after training)
  • Shifts scheduled between 6:00 AM - 7:00 PM MST
  • Includes 2-3 weekend rotating shifts per month
  • Schedules are fixed and released 60 days in advance

Compensation & Expanded Benefits
  • Base salary: $240,000 per year
  • 20 days of Paid Time Off per year
  • 6 company Holidays (New Year's, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas) and 1 Floating Holiday
  • 8 days of Paid Sick Leave
  • Medical and Prescription Benefits administered by Aetna
  • Dental and Vision benefits
  • Basic Life and Accidental Death and Dismemberment (AD&D) Insurance
  • Short-Term & Long-term Disability insurance

Requirements
Skills and Experience
  • Minimum of five years' full-time equivalent experience providing direct clinical care to patients
  • Minimum of five years' experience administering utilization management and peer review programs preferred
  • Credentialed and privileged by the Company's Credentialing Committee
  • Obtain additional state licensure as required for the position

Education:
  • MD/DO degree
  • Current, unrestricted medical license as required for clinical practice in a state of the United States
  • Board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) or other board recognized by URAC preferred

Additionally:
  • Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy.

Work Environment:
Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).
Diversity Statement:
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
Drug-Free Workplace:
This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.
California Consumer Privacy Act (CCPA) Information (California Residents Only):
  • Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver's license number, or state identification card number, and passport number.
  • Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.

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