Utilization Management Nurse Consultant

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

📋 Description

• Evaluate and analyze clinical data to aid in coverage decisions and care management.

• Utilize clinical guidelines, policies, and nursing expertise throughout the care continuum.

• Partner with healthcare providers and multidisciplinary teams to organize care and treatment strategies.

• Recognize opportunities to enhance healthcare quality, benefit utilization, and patient outcomes.

• Guide members to suitable programs and services that promote comprehensive care.

• Work remotely within the state and city of your confirmed residence.

• Function effectively across various monitors, applications, secure systems, and digital communication platforms.

⛳️ Requirements

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

• An Associate Degree in Nursing is required.

• A minimum of 2 years of RN experience in adult acute care or critical care environments.

• Excellent clinical assessment, communication, and multitasking abilities.

• Comfortable in a fast-paced, technology-oriented setting.

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

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

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

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

• Proficiency in using multiple monitors and navigating various applications.

• Ability to utilize digital communication tools, including email, calendar invites, Teams messaging, and virtual meetings.

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

• Capacity to access secure systems such as VPN and EHR portals.

• Adherence to computer security protocols, including screen locking, managing strong passwords, and identifying suspicious emails or links.

• Capability to independently resolve common technical issues.

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

• BSN is preferred.

• 2+ years of Med-Surg or specialty clinical experience is preferred.

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

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial wellness.

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

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

• Flexible remote work environment.