Utilization Management Nurse Consultant

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

📋 Description

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

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

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

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

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

• Advise and provide expertise to both internal and external parties in coordinating and managing utilization and benefit administration.

• Operate in a conventional office setting with expectations for productivity and quality.

• Conduct thorough inspections of handwritten and computer-generated documents as well as PC monitor content.

• Remain seated for extended periods, engage in telephone conversations, and type on a computer.

• Manage multiple tasks, prioritize effectively, and adapt to a dynamic, fast-paced environment.

⛳️ Requirements

• Must reside in the Central Time, Mountain Time, or Pacific Time zones.

• Must possess an active, current, and unrestricted Registered Nurse (RN) license in the state of residence.

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

• Availability to work weekends, holidays, and evening hours as dictated by business needs.

• An Associate's Degree in Nursing or a Nursing Diploma is required.

• A direct/hardwired internet connection to a modem/router within 7 feet of the computer is necessary.

• A minimum internet speed of 25 Mbps for download and 3 Mbps for upload is required.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA guidelines is essential.

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

• Ability to utilize multiple monitors and navigate various applications is required.

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

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

• Ability to access secure systems such as VPN and EHR portals is required.

• Ability to adhere to computer security practices, manage strong passwords, and recognize suspicious emails or links is essential.

• Capability to troubleshoot common technical issues is necessary.

• Strong verbal and written communication skills are required.

• Preferred: At least 2 years of clinical experience in med-surg or a specialty area.

• Preferred: Experience in managed care, particularly in Utilization Management.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.

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

• Remote work from home.

• A comprehensive benefits package for eligible full-time colleagues.