Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona, +9 more states.

📋 Description

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

• Collect clinical information and apply clinical criteria, guidelines, policies, procedures, and judgment to make coverage decisions or recommendations.

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

• Recognize members for referral opportunities involving additional products, services, and programs.

• Identify chances to enhance the quality of healthcare services and optimize benefit utilization.

• Consult and offer expertise to both internal and external stakeholders regarding utilization and benefit management.

• Operate in a 24/7 utilization management environment, including weekends, holidays, and evening hours.

• Execute tasks requiring prolonged sitting, telephone communication, computer usage, multitasking, and adaptation to a fast-paced setting.

⛳️ Requirements

• Minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care environment.

• Current and unrestricted RN licensure in the state of residence.

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

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

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

• Strong verbal and written communication abilities.

• Experience with Microsoft Office 365 (including Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace tools.

• Capability to utilize secure systems such as VPNs and EHR portals.

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

• Ability to independently resolve common technical issues.

• Direct/hardwired internet connection within 7 feet of modem/router, with a minimum of 50 Mbps download and 5 Mbps upload speeds.

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

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

• Required to provide own workspace furniture.

• Must meet the required internet speeds and follow Work From Home guidelines if hired.

• Associate degree is required.

🏝️ 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 keyboard, monitor, computer, headset, etc.).