Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Alabama, +17 more states.

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess healthcare services and benefit options for members.

• Collect clinical information and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations or recommendations.

• Communicate with providers and other stakeholders to facilitate care and treatment.

• Identify members for referral opportunities related to other products, services, or programs.

• Recognize opportunities to enhance the quality of healthcare services and effective utilization of benefits.

• Provide consultation and expertise to both internal and external stakeholders regarding utilization and benefit management coordination and administration.

• Operate in a standard office environment, meeting productivity and quality expectations.

• Conduct detailed inspections of handwritten and computer-generated documents, as well as content on PC monitors.

• Remain seated for extended periods, engage in telephone conversations, and type on a computer.

• Manage multiple tasks, prioritize effectively, and adapt to a dynamic, fast-paced environment.

⛳️ Requirements

• An active and unrestricted Registered Nurse (RN) license in the candidate’s state of residence.

• Minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care setting.

• Availability to work on weekends, holidays, and during evening hours as necessary.

• An Associate's Degree in Nursing is required.

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

• Minimum internet speeds of 25 Mbps for download and 3 Mbps for upload are required.

• WiFi and satellite internet connections are not acceptable.

• 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 navigate multiple systems and applications concurrently.

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

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

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

• Competence in following computer and password security practices and recognizing suspicious emails or links.

• Ability to independently troubleshoot common technical issues.

• A Bachelor's Degree in Nursing is preferred.

• At least 2 years of clinical experience in medical-surgical or specialty areas is desirable.

• Experience in managed care or Utilization Management is preferred.

• Preference will be given to candidates residing in Eastern Standard Time (EST) zones.

🏝️ Benefits

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

• Medical coverage is provided.

• Dental coverage is included.

• Vision coverage is available.

• Paid time off is offered.

• Retirement savings options are provided.

• Access to wellness programs.

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

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

• Opportunity for remote work from a designated home workspace.