Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Evaluate and analyze clinical data for Medicare precertification related to joint procedures.

• Utilize evidence-based guidelines and clinical expertise to determine coverage eligibility.

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

• Recognize opportunities for enhancing care quality and maximizing healthcare resource utilization.

• Link members to additional programs and services for effective care integration.

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

• Work Monday through Friday from 9:00 am to 5:30 pm in the employee's time zone, with occasional evening and holiday shifts.

• Operate remotely from a specified home workspace.

⛳️ Requirements

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

• Over 3 years of RN experience.

• At least 1 year of Med/Surg experience.

• Proficiency in Microsoft Office applications (Outlook, Teams, Excel).

• Associate degree in nursing.

• Must reside and work within the same state and city.

• 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 acceptable.

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

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

• Proficient in using Microsoft Office 365 applications or similar Google Workspace tools.

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

• Familiarity with computer, password, and email security protocols.

• Aptitude for troubleshooting common technical issues.

• Willingness to learn new skills as the work environment evolves.

🏝️ Benefits

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

• 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.).

• Remote work from home.

• Consistent weekday schedule with some flexibility for a 24/7 operation.