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 enable suitable healthcare services and benefits for members.

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

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

• Identify members for referral opportunities by integrating various products, services, and programs.

• Recognize opportunities to enhance the quality of healthcare services and optimize benefit utilization.

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

• Operate within a 24/7 utilization management framework, including weekend, holiday, and evening shifts.

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

• Review handwritten and computer-generated documents, as well as information displayed on PC monitors.

• Remain seated for extended durations, communicate via telephone, type on a computer, multitask, prioritize tasks, and adjust to a fast-paced evolving 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.

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

• An Associate's Degree is required.

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

• Strong verbal and written communication skills.

• Capability to use multiple monitors and applications concurrently.

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

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

• Capacity to log into secure systems such as VPN and EHR portals.

• Proficient 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 the modem/router with at least 50 Mbps download and 5 Mbps upload speeds.

• A quiet, secure, private, and HIPAA-compliant designated home workspace.

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

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

• Must meet the necessary internet speed requirements and comply with Work From Home policies if hired.

🏝️ 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.).