Utilization Management Nurse Consultant

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

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess options to ensure suitable healthcare services and benefits for members.

• Collect clinical data and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage decisions or recommendations throughout the care continuum.

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

• Recognize members for referral opportunities to other products, services, and programs.

• Discover opportunities to enhance the quality of healthcare services and effective benefit utilization.

• Provide consultation and expertise to both internal and external parties in the coordination and management of utilization and benefits.

• Operate within a 24/7 utilization management environment, which may include weekends, holidays, and evening hours.

• Achieve productivity and quality standards in a standard office working environment.

• Conduct thorough inspections of handwritten and computer-generated documents as well as PC monitors.

• Remain seated for extended periods, communicate via telephone, type, multitask, prioritize, and adjust to a fast-paced, dynamic environment.

• Navigate various systems and applications while troubleshooting common technical issues.

⛳️ Requirements

• A minimum of 2 years of clinical experience as a Registered Nurse in a hospital environment focused on adult acute care or critical care.

• Must possess active, current, and unrestricted RN licensure in your state of residence.

• Utilization Management schedules may require working on weekends, holidays, and evenings.

• Strong verbal and written communication skills are essential.

• Proficient computer skills, including navigating multiple systems and keyboarding abilities.

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

• Minimum internet speed requirements are 25 Mbps for downloads and 3 Mbps for uploads.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, and private designated home work location must comply with CVSHealth and HIPAA standards.

• Employment must be conducted within the state and city of current residence.

• Candidates must supply their own workspace furniture.

• Ability to set up and utilize multiple monitors while navigating numerous applications concurrently.

• Competence in using email, calendar invites, Teams messaging, and participating in virtual meetings.

• Experience with Microsoft Office 365 applications or comparable Google Workspace tools is preferred.

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

• Must be capable of managing strong passwords and identifying suspicious emails or links.

• Ability to independently resolve common technical issues.

• An Associate or Bachelor of Science in Nursing is required; a BSN is preferred.

• Preferred candidates should have 3 or more years of clinical experience in adult medical-surgical or specialty areas.

• Experience in Managed Care is preferred, particularly in Utilization Management.

• Preference will be given to candidates residing in the CST time zone.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off benefits.

• Retirement savings options available.

• Wellness programs offered.

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

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

• Opportunity for remote work from home.