Utilization Management Nurse Consultant

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

📋 Description

• Evaluate, strategize, 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 professional judgment to make coverage decisions or recommendations throughout the care continuum.

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

• Recognize members for referral possibilities to various products, services, and programs.

• Identify opportunities to enhance the quality of healthcare services and effective utilization of benefits.

• Consult with and offer expertise to both internal and external stakeholders in the coordination and administration of utilization and benefit management.

• Operate in a typical office environment with expectations for productivity and quality while working remotely.

⛳️ Requirements

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

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

• An Associate Degree in Nursing is mandatory.

• Preference for candidates located in CST or EST time zones.

• Availability for evenings, weekends, and holidays as part of a 24/7 operational schedule.

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

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

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

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

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

• Ability to sit for prolonged periods, communicate via telephone, and type on a computer.

• Capacity to multitask, prioritize, and adapt to a rapidly changing environment.

• Proficiency in navigating multiple computer systems and keyboarding.

• Strong verbal and written communication skills.

• Ability to utilize multiple monitors and applications concurrently.

• Competence in using email, calendar invitations, Teams messaging, and virtual meeting tools.

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

• Ability to log into secure systems such as VPN and EHR portals, adhere to computer security practices, and identify suspicious emails or links.

• Proficiency in independently troubleshooting common technical issues.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off benefits.

• Options for retirement savings.

• Wellness programs available.

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

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