Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Arizona, +8 more states.

📋 Description

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

• Partner with providers and interdisciplinary care teams to facilitate treatment planning.

• Utilize clinical judgment in utilization management and prior authorization processes.

• Recognize opportunities for enhancing quality, outcomes, and member satisfaction.

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

• Transition clinical knowledge into a cooperative, non-bedside role.

• Assist in healthcare operations, utilization management, and managed care.

⛳️ Requirements

• Current, unrestricted RN license in the state of residence.

• At least 3 years of RN experience, with a minimum of 1 year in Medical-Surgical Nursing.

• Excellent clinical assessment, critical thinking, and decision-making abilities.

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

• Associate Degree in Nursing (ADN) required.

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

• Schedules may occasionally include evenings, weekends, and holidays based on business requirements.

• Direct wired internet connection with a minimum of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not allowed.

• A dedicated, private workspace that meets HIPAA and company security standards.

• Capability to work from the confirmed state and city of residence.

• Ability to manage multiple monitors and applications at the same time.

• Experience with Microsoft 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar tools.

• Proficient in securely accessing systems, including VPNs and healthcare applications.

• Basic troubleshooting skills for resolving connectivity and application issues.

• Willingness to learn new technologies and adapt to changing business needs.

🏝️ 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.

• Retirement savings options.

• Wellness programs.

• Company-provided computer, monitor(s), keyboard, and headset.

• Opportunities for professional growth and development.

• Remote work with a supportive and experienced team.