Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and apply evidence-based guidelines to provide utilization and coverage recommendations.

• Collaborate with healthcare providers and teams to facilitate suitable treatment plans and care coordination.

• Identify areas for enhancement in healthcare quality, outcomes, and benefit utilization.

• Refer members to additional programs and services that meet their healthcare requirements.

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

• Work schedules may include evenings, weekends, and holidays in a 24/7 operational environment.

• Operate from a designated home workspace while adhering to Work From Home, HIPAA, internet, security, and equipment standards.

⛳️ Requirements

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

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

• Excellent communication, critical thinking, and multitasking abilities.

• Proficient in navigating various computer systems.

• Associate's Degree in Nursing is mandatory.

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

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

• WiFi and satellite internet connections are not acceptable.

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

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

• Capability to use multiple monitors and navigate several applications simultaneously.

• Proficient in digital communication methods including email, calendar invites, Teams messaging, and virtual meetings.

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

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

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

• Ability to independently troubleshoot common technical issues.

• Willingness to learn new skills as the workplace evolves.

• Preferred: 2+ years of Med-Surg or specialty clinical experience.

• Preferred: Experience in Managed Care and/or Utilization Management.

• Preferred: Candidates residing in Central or Eastern time zones.

• Preferred: BSN degree.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Company-provided equipment such as keyboard, monitor, computer, and headset.

• Remote work from home.