Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona, +8 more states.

📋 Description

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

• Collaborate with healthcare providers and care teams to ensure appropriate treatment coordination.

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

• Identify areas for enhancing care quality and improving member outcomes.

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

• Adhere to a weekday schedule within a 24/7 utilization management operation, which may include holidays and evening shifts.

⛳️ Requirements

• Active and unrestricted RN license in your state of residence.

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

• Strong skills in clinical assessment and decision-making.

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

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

• An Associate Degree in Nursing is required.

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

• Minimum internet speed of 25 Mbps download and 3 Mbps upload.

• WiFi and satellite internet are not acceptable.

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

• Must be employed within the state and city of current residence.

• Provision of workspace furniture such as a desk or standing desk is necessary.

• Capability to utilize multiple monitors and navigate various applications.

• Competence in communicating via email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Skill in managing strong passwords and identifying suspicious emails or links.

• Ability to independently resolve common technical issues.

• Willingness to learn new skills.

• BSN is preferred.

• Experience in Utilization Management or Prior Authorization, managed care background, familiarity with MedCompass, and ambulatory surgery experience are desirable.

🏝️ 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, including a keyboard, monitor, computer, headset, etc.