Utilization Management Nurse Consultant

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

📋 Description

• Assess clinical cases and determine coverage using evidence-based guidelines.

• Work collaboratively with providers and care teams to ensure appropriate treatment coordination.

• Utilize clinical judgment in making utilization and benefit management decisions.

• Identify ways 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 role that does not involve bedside care.

• Assist in care coordination and healthcare quality initiatives for members.

⛳️ Requirements

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

• 3+ years of RN experience, which must include at least 1 year in Med/Surg.

• Strong skills in clinical assessment and decision-making.

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

• Availability to work Monday–Friday, from 9:00 AM to 6:00 PM in your time zone; schedules may include holidays and evening shifts.

• Associate Degree in Nursing.

• Direct or hardwired internet connection within 7 feet of the modem/router.

• 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 home workspace that complies with CVS Health and HIPAA guidelines.

• Must work within the state and city where currently residing.

• Capability to use multiple monitors and applications simultaneously.

• Proficiency in digital communication channels and virtual meeting platforms.

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

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

• Adherence to computer and password security protocols, as well as the ability to recognize suspicious emails or links.

• Competence in troubleshooting common technical issues independently.

• Willingness to learn new skills.

• BSN is preferred.

🏝️ Benefits

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

• Medical, dental, and vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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