Utilization Management Nurse Consultant

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

📋 Description

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

• Oversee, coordinate, assess, and evaluate healthcare services throughout the care continuum

• Partner with healthcare providers and care teams to enable suitable treatment plans

• Recognize chances to enhance quality, efficiency, and healthcare resource utilization

• Link members to additional programs and services as necessary

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

• Operate in a remote, non-bedside utilization management capacity

• Available for afternoon/evening shifts within a 24/7 operational framework

• Commit to a 40-hour workweek

⛳️ Requirements

• Active and unrestricted RN license in your state of residence

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

• Strong clinical evaluation and decision-making capabilities

• Proficiency in navigating various computer systems and managing conflicting priorities

• Exceptional verbal and written communication skills

• An Associate Degree in Nursing is required

• Willingness to work weekends, holidays, and evening shifts

• 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 workspace compliant with CVS Health and HIPAA standards

• Must work within the state and city of current residence

• Capability to utilize multiple monitors and applications simultaneously

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

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

• Ability to log into secure systems such as VPN and EHR portals

• Competence in following computer security protocols, including screen locking, strong passwords, and recognizing suspicious links

• Ability to troubleshoot common technical issues and contact IT support when necessary

• Willingness to acquire new skills

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

• Preferred: Experience in Managed Care, especially in Utilization Management

• Preferred: Residency in the Eastern Time Zone

• BSN is preferred

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

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

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

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