Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

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

• Collect clinical data and utilize clinical criteria, guidelines, policies, procedures, and judgment to make coverage determinations or recommendations.

• Engage with providers and other stakeholders to promote care and treatment.

• Identify members for referral opportunities related to other products, services, or programs.

• Recognize opportunities to enhance healthcare service quality, effectiveness, and benefit utilization.

• Consult with and provide expertise to internal and external stakeholders in the coordination and administration of utilization and benefit management.

• Operate in a standard office environment with expectations for productivity and quality.

• Conduct detailed inspections of handwritten and computer-generated documents and PC displays.

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

⛳️ Requirements

• A minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care setting.

• Active, current, and unrestricted RN licensure in the state of residence.

• Associate Degree required.

• At least 2 years of clinical experience in medical-surgical or a specialty area.

• Managed Care experience preferred, particularly in Utilization Management.

• Preference for candidates living in PST zones.

• Availability to work weekends, holidays, and evening hours in a 24/7 operation.

• Proficiency with computer skills, navigating multiple systems, and keyboarding.

• Strong verbal and written communication skills.

• 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 permitted.

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA guidelines.

• Ability to work within the state and city of current residence.

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

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

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

• Capability to access secure systems such as VPN and EHR portals and adhere to computer and password security practices.

• Ability to troubleshoot common technical issues and reach out to IT 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.

• 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 (keyboard, monitor, computer, headset, etc.).