Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Alabama, +27 more locations.

📋 Description

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

• Partner with providers and care teams to facilitate suitable treatment options.

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

• Recognize opportunities for enhancing care quality and improving 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

• Possession of an active, unrestricted RN license in the state of residence.

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

• Strong skills in clinical assessment and decision-making.

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

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

• An Associate Degree in Nursing is required.

• Capability to establish a direct/hardwired internet connection to a modem/router located within 7 feet of the computer.

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

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

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

• Required to furnish workspace furniture, such as a desk or standing desk.

• Comfortable with setting up and using multiple monitors while navigating various applications.

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

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

• Ability to log into secure systems, including VPN and EHR portals.

• Competence in following computer security protocols, such as locking screens, managing strong passwords, and identifying suspicious emails or links.

• Capacity to independently resolve common technical issues and reach out to IT for more complex problems.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• 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.

• Opportunity for remote work from home.