Utilization Management Nurse Consultant

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

📋 Description

• Examine clinical data and utilize established guidelines, policies, and clinical judgment to assist in coverage decisions.

• Evaluate, coordinate, monitor, and assess healthcare services and benefits throughout the continuum of care.

• Partner with providers and care teams to ensure appropriate treatment and care planning.

• Discover opportunities to enhance the quality of care, improve member outcomes, and optimize healthcare utilization.

• Link members to supplementary programs and resources that support their healthcare needs.

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

• Operate within a 24/7 utilization management environment, with potential evening, weekend, and holiday shifts.

• Frequently collaborate with providers, members, and interdisciplinary healthcare teams.

• Achieve productivity and quality standards in a remote, computer-based position.

⛳️ Requirements

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

• Minimum of 2 years of experience in adult acute care and/or critical care nursing.

• Strong skills in clinical assessment, critical thinking, and decision-making.

• Exceptional verbal and written communication abilities.

• Capacity to multitask and thrive in a fast-paced environment.

• Proficiency in navigating various computer systems and applications.

• An Associate Degree in Nursing is required.

• Experience in Med-Surg or specialty nursing is preferred.

• Preferred background in Managed Care or Utilization Management.

• Residence in the Eastern Time Zone is preferred.

• BSN is preferred.

• Capability to secure a direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speed of 25 Mbps for downloads and 3 Mbps for uploads.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, private home workspace that adheres to CVS Health and HIPAA guidelines is required.

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

• Ability to utilize multiple monitors and applications at the same time.

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

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

• Capability to access secure systems like VPN and EHR portals.

• Adherence to computer security protocols, including screen locking, strong password management, and recognizing suspicious emails or links.

• Ability to troubleshoot common technical issues and reach out to IT when necessary.

• Willingness to acquire new skills as the workplace evolves.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Company-provided work equipment, including keyboard, monitor, computer, and headset.

• Opportunity to work remotely from home.

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