Nurse Consultant, Utilization Management

This is a fully remote position, open to applicants in New Jersey, +3 more states.

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess options to provide suitable healthcare services and benefits for members.

• Collect clinical data and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations or recommendations.

• Liaise with providers and other stakeholders to facilitate care and treatment.

• Identify members for potential referral opportunities involving other products, services, or programs.

• Recognize opportunities to enhance the quality of healthcare services and effective benefit utilization.

• Consult with and offer expertise to internal and external parties in coordinating and managing utilization and benefit processes.

• Operate within a 24/7 utilization management environment, including weekends, holidays, and evening shifts.

• Achieve productivity and quality standards in a standard office setting.

• Conduct thorough inspections of handwritten and computer-generated documents and PC monitors.

• Remain seated for extended periods, engage in telephone conversations, type, multitask, prioritize, and adapt to a rapidly changing environment.

⛳️ Requirements

• A minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care setting.

• Active, current, and unrestricted RN licensure in the candidate's state of residence.

• Availability to work weekends, holidays, and evening shifts in a 24/7 operation.

• At least 2 years of clinical experience in medical-surgical or specialty areas.

• Experience in Managed Care is preferred, particularly in Utilization Management.

• Preference for candidates residing in the Eastern Time zone.

• An Associate Degree is required.

• Proficient in computer skills, with experience in multiple systems and keyboarding.

• Familiarity with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications.

• Ability to utilize multiple monitors and applications concurrently.

• Competency in using email, calendar invites, Teams messaging, and virtual meetings.

• Capability to access secure systems like VPN and EHR portals.

• Understanding of computer security practices, including strong passwords and recognizing suspicious emails or links.

• Ability to independently resolve common technical issues.

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speed of 50 Mbps for downloads and 5 Mbps for uploads.

• A quiet, secure, private, and designated home workspace that complies with CVS Health and HIPAA regulations.

• Must work within the state and city of current residence.

• Must provide workspace furniture, such as a desk or standing desk.

• Must meet required internet speeds and comply with Work From Home policies if hired.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Company-provided equipment including keyboard, monitor, computer, headset, etc.