Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona, +4 more states.

📋 Description

• Evaluate clinical cases and determine coverage based on evidence-based guidelines.

• Partner with providers and care teams to facilitate suitable treatment options.

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

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

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

• Transition clinical expertise into a collaborative, non-bedside position.

• Assist in care coordination and healthcare quality initiatives.

⛳️ Requirements

• Current 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.

• Proficiency in Microsoft Office applications, including Outlook, Teams, and Excel.

• Availability to work Monday–Friday, from 9:00 AM to 5:30 PM in your time zone.

• Work schedules may include holidays and evening shifts due to the 24/7 nature of Utilization Management.

• Associate Degree in Nursing required.

• Experience in Utilization Management or Prior Authorization is preferred.

• Background in managed care is a plus.

• Familiarity with MedCompass is advantageous.

• Experience in ambulatory surgery is a benefit.

• BSN is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Comprehensive benefits package available for eligible full-time colleagues and their families.