Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Alabama, +26 more states.

📋 Description

• Evaluate clinical cases and make coverage decisions based on evidence-based guidelines.

• Partner with providers and care teams to facilitate appropriate treatment plans.

• Utilize clinical judgment to assist in utilization and benefit management decisions.

• Spot opportunities to enhance care quality and improve member outcomes.

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

• Transition clinical expertise into a collaborative, non-bedside position.

• Aid in care coordination and the advancement of healthcare quality.

⛳️ Requirements

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

• A minimum of 3 years of RN experience, including at least 1 year in Med/Surg.

• Excellent clinical assessment and decision-making abilities.

• Proficient in Microsoft Office, including Outlook, Teams, and Excel.

• Availability to work Monday through Friday, from 9:00 AM to 5:30 PM in your local time zone.

• Work schedules may include holidays and evening hours, as Utilization Management operates 24/7.

• Associate Degree in Nursing required.

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

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

• WiFi and satellite internet connections are not permitted.

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

• Must reside in the state and city where you are currently living.

• Must supply workspace furniture, such as a desk or standing desk.

• Capability to use multiple monitors and navigate various applications.

• Proficiency in digital communication tools, including email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to access secure systems, including VPN and EHR portals.

• Knowledge of computer security practices, such as locking screens, managing strong passwords, and identifying suspicious emails or links.

• Skills to troubleshoot common technical issues and contact IT for unresolved problems.

• Willingness to learn new skills as the workplace evolves.

• Experience in Utilization Management or Prior Authorization, a managed care background, familiarity with MedCompass, and ambulatory surgery experience are preferred.

• BSN is preferred.

🏝️ 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.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial wellness.

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

• Remote work arrangement.