Utilization Management Nurse Consultant

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

📋 Description

• Evaluate and analyze clinical data to assist with coverage decisions and recommendations.

• Utilize evidence-based clinical standards, policies, and professional judgment throughout the care continuum.

• Work in partnership with healthcare providers and interdisciplinary teams to coordinate care and enhance positive outcomes for members.

• Recognize opportunities for improving quality, integrating care, and optimizing benefit utilization.

• Act as a clinical resource for both internal and external stakeholders.

• Operate remotely while applying clinical knowledge to impact quality outcomes and healthcare resource management.

⛳️ Requirements

• Valid and unrestricted RN license in your state of residence.

• At least 2 years of RN experience in an adult acute care or critical care environment.

• Associate's degree in nursing.

• Over 2 years of experience in Med-Surg or a specialized clinical area (preferred).

• Experience in Utilization Management and/or Managed Care (preferred).

• Excellent communication, critical thinking, and computer navigation skills (preferred).

• Ability to excel in a fast-paced setting and handle multiple priorities (preferred).

• Candidates residing in the Eastern Time Zone are highly preferred.

• BSN is preferred.

• Direct, wired internet connection to a modem/router within 7 feet of the computer, with a minimum of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not acceptable.

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

• Capability to work within the state and city where the candidate currently resides.

• Ability to provide necessary workspace furniture, such as a desk or standing desk.

• Comfort with setting up and utilizing multiple monitors and navigating various applications.

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

• Experience with Microsoft Office 365 applications or similar Google Workspace applications.

• Ability to access secure systems such as VPNs and EHR portals, manage strong passwords, and identify suspicious emails or links.

• Competence in troubleshooting common technical issues and contacting IT support when necessary.

• Willingness to learn new skills as the workplace evolves.

• Availability for shifts that may include evenings, weekends, and holidays as part of a 24/7 operation.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Remote work opportunity.

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

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