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 based on evidence-based guidelines.

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

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

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

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

• Maintain a weekday schedule, with potential for holiday and evening shifts due to 24/7 operations.

⛳️ Requirements

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

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

• Strong clinical assessment and decision-making capabilities.

• Proficient in Microsoft Office (Outlook, Teams, Excel).

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

• Associate Degree in Nursing.

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

• 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.

• Designated home workspace that is quiet, secure, and compliant with CVS Health and HIPAA guidelines.

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

• Comfortable using multiple monitors and navigating various applications.

• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.

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

• Capability to access secure systems, including VPN and EHR portals.

• Ability to adhere to computer security practices, manage strong passwords, and identify suspicious emails or links.

• Competence in troubleshooting common technical issues independently.

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

• Opportunity for remote work from home.

• Supportive, team-oriented work environment.