Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona, +10 more states.

📋 Description

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

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

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

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

• Discover opportunities to enhance the quality of healthcare services and ensure effective utilization of benefits.

• Advise and offer expertise to both internal and external parties in managing utilization and benefits.

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

• Conduct thorough reviews of both handwritten and digitally generated documents and computer screens.

• Remain seated for extended durations, engage in phone conversations, operate a computer, multitask, prioritize tasks, and adapt to a dynamic work environment.

⛳️ Requirements

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

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

• An Associate's Degree is required.

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

• Preferred experience in Managed Care, particularly in Utilization Management.

• Candidates residing in PST time zones will be given preference.

• Strong computer skills, including the ability to navigate multiple systems and proficient keyboarding.

• Excellent verbal and written communication abilities.

• Willingness to work weekends, holidays, and evenings in a 24/7 operational setting.

• A direct or 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 acceptable.

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

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

• Proficient in setting up and using multiple monitors and navigating various applications.

• Familiarity with email, calendar invitations, Teams messaging, and virtual meetings.

• Experience using Microsoft Office 365 applications or comparable Google Workspace applications.

• Ability to log into secure systems such as VPN and EHR portals, maintain computer security, manage strong passwords, and identify suspicious emails or links.

• Skill in troubleshooting common technical issues and reaching out to IT support 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 insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Company-provided equipment (keyboard, monitor, computer, headset, etc.).