Utilization Management Nurse Consultant

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

📋 Description

• Analyze clinical data and utilize evidence-based criteria to provide coverage recommendations.

• Work collaboratively with physicians, providers, and care teams to ensure seamless treatment and services.

• Recognize opportunities to enhance quality, outcomes, and efficient use of healthcare resources.

• Assist members by referring them to supplementary programs and services as needed.

• Participate in a dynamic, team-focused environment dedicated to delivering outstanding care.

• Impact care decisions and enhance member outcomes.

⛳️ Requirements

• Active, unrestricted RN license in your state of residence is necessary.

• A minimum of 2 years of recent RN experience in adult acute care or critical care is required.

• An Associate Degree in Nursing is mandatory.

• Experience in Medical-Surgical (Med-Surg) nursing or other specialty areas is preferred.

• Previous experience in Utilization Management or Managed Care is an advantage.

• Strong skills in clinical assessment, critical thinking, and communication are essential.

• Proficiency in navigating multiple computer systems and managing competing priorities is required.

• Preference will be given to residents of the Central Time Zone or Mountain Time Zone.

• Must be available to work evenings, weekends, and holidays as necessary.

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

• Minimum internet speed of 25 Mbps download and 3 Mbps upload is required.

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

• Must be able to work within the state and city where currently residing.

• Ability to provide ergonomic furniture for prolonged desk-based work is required.

• Capability to use multiple monitors and applications concurrently is a must.

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

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

• Ability to log into secure systems such as VPN and EHR portals is essential.

• Must adhere to computer and password security practices and recognize suspicious emails or links.

• Ability to resolve common technical issues and contact IT support when necessary is required.

• Willingness to learn new skills as the workplace evolves is essential.

🏝️ Benefits

• 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 (keyboard, monitor, computer, headset, etc.).

• Opportunities for professional growth.

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