Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona.

📋 Description

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

• Collect clinical information and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage decisions or recommendations.

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

• Identify members for referral opportunities related to additional products, services, or programs.

• Discover opportunities to enhance healthcare service quality and benefit utilization.

• Provide consultation and expertise to both internal and external parties regarding utilization and benefit management.

• Participate in a 24/7 utilization management operation, which includes working on weekends, holidays, and evenings.

• Conduct duties in a home office setting while meeting productivity and quality standards.

• Review handwritten and computer-generated documents as well as content displayed on PC monitors.

• Navigate multiple computer systems and applications while typing, communicating over the phone, and multitasking.

⛳️ Requirements

• Minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care environment.

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

• An Associate's Degree is required.

• At least 2 years of clinical experience in medical-surgical or a specialized area.

• Willingness to work weekends, holidays, and evening hours in a 24/7 operational setting.

• Strong verbal and written communication skills.

• Proficiency in computer usage, including the ability to navigate multiple systems and keyboard effectively.

• Capability to utilize Microsoft Office 365 applications or similar Google Workspace applications.

• Familiarity with secure systems such as VPN and EHR portals.

• Capacity to secure a hardwired internet connection with minimum speeds of 50 Mbps download and 5 Mbps upload.

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

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

• Ability to remain seated for extended periods and perform sedentary tasks.

• Skills in multitasking, prioritizing, and adapting to a fast-paced, changing environment.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

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