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 provide appropriate healthcare services and benefits for members.

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

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

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

• Discover opportunities to enhance healthcare service quality and effective benefit utilization.

• Consult with internal and external partners on utilization and benefit management.

• Operate within a 24/7 environment, including weekends, holidays, and evening hours.

• Achieve productivity and quality standards in a typical office setting.

• Conduct thorough inspections of handwritten and computer-generated documents and PC monitors.

• Remain seated for extended periods, engage in telephone conversations, type, and multitask.

⛳️ Requirements

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

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

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

• Managed care experience is preferred, particularly in Utilization Management.

• Preference for candidates living in Pacific Standard Time zones.

• An Associate Degree is required.

• A Bachelor of Science in Nursing (BSN) is preferred.

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

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

• WiFi and satellite internet connections are not acceptable.

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

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

• Proficiency in computer skills, multiple systems, and keyboarding is required.

• Strong verbal and written communication abilities are necessary.

• Availability to work on weekends, holidays, and during evening hours is required.

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

• Ability to navigate secure systems such as VPN and EHR portals is essential.

• Capacity to troubleshoot common technical issues and adhere to security practices 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 (keyboard, monitor, computer, headset, etc.).

• Opportunity to work remotely from home.