Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Connecticut, +20 more states.

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess healthcare services and benefit options.

• Collect clinical information and apply clinical criteria, guidelines, policies, procedures, and professional judgment.

• Make coverage determinations or recommendations throughout the continuum of care.

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

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

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

• Provide consultation and expertise to both internal and external stakeholders.

• Oversee and manage utilization and benefit management functions.

• Maintain a permanent work schedule from Monday to Friday, 8 a.m. to 5 p.m. EST.

• Support a 24/7 utilization management operation that may involve weekends, holidays, and evening hours.

⛳️ Requirements

• A minimum of 3 years of experience as an acute care RN.

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

• Proficient in multiple IT platforms and systems.

• At least 1 year of experience with Microsoft Office Applications (Outlook, Teams, Excel).

• An Associate's Degree in Nursing is required.

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speeds of 25 Mbps download and 3 Mbps upload are required.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA guidelines.

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

• Ability to utilize multiple monitors and navigate several applications simultaneously.

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

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

• Must maintain computer and information security protocols.

• Ability to troubleshoot common technical issues effectively.

• Willingness to meet the required internet speeds and adhere to Work From Home guidelines.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• 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 including keyboard, monitor, computer, and headset.