Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and utilize evidence-based criteria to provide coverage recommendations.

• Work in partnership with providers and interdisciplinary teams to enhance care coordination.

• Discover opportunities to enhance quality, outcomes, and the utilization of healthcare resources.

• Direct members to suitable programs and services that cater to their healthcare requirements.

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

• Contribute to the 24/7 Utilization Management team.

• Evaluate medical necessity and coordinate patient care.

• Leverage clinical judgment to improve healthcare outcomes.

⛳️ 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.

• Associate Degree in Nursing (ADN).

• Exceptional communication, multitasking, and computer skills.

• Flexibility to work various schedules, including evenings, weekends, and holidays.

• Must possess or be able to establish a 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 allowed.

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

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

• Capability to set up and operate multiple monitors and navigate various applications.

• Proficient in communicating through email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Competence in adhering to computer security best practices, including screen locking, managing strong passwords, and identifying suspicious emails or links.

• Ability to troubleshoot common technical issues independently and reach out to IT for unresolved problems.

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

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

• BSN is preferred.

• Candidates from the Eastern Time Zone are preferred.

🏝️ Benefits

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

• Comprehensive 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.).

• Opportunity to have a direct impact on member care and outcomes.

• Collaborative, mission-driven healthcare environment.