Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Alabama, +32 more states.

📋 Description

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

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

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

• Identify avenues 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 role centered on care coordination and healthcare quality.

⛳️ Requirements

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

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

• Excellent clinical assessment and decision-making abilities.

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

• Availability to work Monday to Friday, 9:00 AM to 5:30 PM in your time zone; schedules may include holidays and evening shifts.

• Associate Degree in Nursing.

• Direct, hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not acceptable.

• A quiet, secure, and private designated home work location that complies with CVS Health and HIPAA guidelines.

• Must reside and work within the state and city of current residence.

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

• Capable of setting up and using multiple monitors and navigating various applications.

• Proficient in using digital communication tools such as email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to log in to secure systems including VPN and EHR portals, manage strong passwords, and recognize phishing emails or links.

• Capable of troubleshooting common technical issues and contacting IT support when necessary.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental insurance.

• Vision insurance.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

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

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

• Supportive, team-oriented work environment.