Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical information and utilize evidence-based criteria to assist in coverage decisions.

• Partner with providers and interdisciplinary teams to facilitate care coordination and enhance outcomes.

• Recognize opportunities to elevate healthcare quality, efficiency, and member satisfaction.

• Connect members with additional programs and services as needed.

• Act as a clinical resource for utilization and benefit management efforts.

• Operate in a dynamic, team-oriented remote environment with established productivity and quality objectives.

• Maintain a flexible schedule that includes evenings, weekends, and holidays as part of a 24/7 service operation.

⛳️ Requirements

• Possess an active, unrestricted RN license in your state of residence.

• Have 2+ years of RN experience in adult acute care or critical care settings.

• Hold an Associate Degree in Nursing (ADN).

• Candidates must be located in the Eastern or Central Time Zone.

• Demonstrate strong clinical judgment, communication abilities, and computer proficiency.

• Have experience in Medical-Surgical or specialty nursing.

• Possess experience in Utilization Management or Managed Care.

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

• Ensure a minimum internet speed of 25 Mbps download and 3 Mbps upload.

• Provide a quiet, secure, private designated home virtual work location that complies with CVS Health and HIPAA guidelines.

• Ability to work within your current state and city of residence.

• Capability to supply workspace furniture.

• Proficiency in using multiple monitors and navigating various applications.

• Familiarity with email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Knowledge of computer security practices, including screen locking, strong password management, and identifying suspicious emails or links.

• Competence in independently troubleshooting common technical issues.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

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

• Flexible scheduling, including evenings, weekends, and holidays as part of a 24/7 operation.