Utilization Management Nurse Consultant

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

📋 Description

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

• Collect clinical data and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations or recommendations throughout the continuum of care.

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

• Recognize members for referral opportunities related to other products, services, and programs.

• Discover opportunities to enhance the quality, effectiveness, and utilization of healthcare services.

• Advise and share expertise with both internal and external parties regarding utilization and benefit management.

• Operate in a standard office setting while achieving productivity and quality standards.

⛳️ Requirements

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

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

• An Associate's Degree is required.

• Clinical experience in medical-surgical or specialty areas.

• Availability to work weekends, holidays, and evenings in a 24/7 operational setting.

• Proficient in computer skills, including navigating multiple systems and keyboarding.

• Strong verbal and written communication abilities.

• Capability to multitask, prioritize, and adapt effectively in a fast-paced environment.

• Ability to closely inspect handwritten and computer-generated documents as well as a PC monitor.

• Capacity to sit for extended periods, communicate via telephone, and use a computer for typing.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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