Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Evaluate and analyze clinical data to assist in coverage determinations and care recommendations.

• Utilize clinical guidelines, policies, and professional judgment in making utilization management decisions.

• Work alongside providers and interdisciplinary teams to coordinate care and develop treatment plans.

• Recognize opportunities for care management referrals and enhanced member support services.

• Advocate for quality outcomes, efficient healthcare utilization, and member-focused care.

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

• Operate within a 24/7 schedule, including evenings, weekends, and holidays.

• Maintain a designated home workspace, adhering to work-from-home, security, and HIPAA standards.

• Set up and utilize multiple monitors and applications effectively.

• Communicate through email, calendar invitations, Teams, and virtual meetings.

• Address common technical issues independently and reach out to IT for unresolved matters.

⛳️ Requirements

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

• Minimum of 2 years of RN experience in adult acute care or critical care environments.

• Associate Degree in Nursing (ADN) is required.

• Excellent communication, critical thinking, and multitasking abilities.

• Proficient in navigating multiple computer systems within a high-volume setting.

• 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.

• A quiet, secure, private designated home work location that meets CVS Health and HIPAA standards.

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

• Capability to utilize multiple monitors and handle several applications at once.

• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to log in to secure systems such as VPN and EHR portals.

• Competency in following computer and password security protocols and identifying suspicious emails or links.

• Skill in independently resolving common technical issues.

• Willingness to learn new skills as the workplace environment changes.

• Preferred: 2+ years of Med-Surg or specialty clinical experience.

• Preferred: Experience in Utilization Management or Managed Care.

• BSN is preferred.

• Candidates located in the Eastern or Central Time Zones are preferred.

• Qualified applicants with arrest or conviction records will be evaluated in accordance with applicable federal, state, and local laws.

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental insurance.

• Vision benefits.

• Paid time off for personal use.

• Retirement savings opportunities.

• Wellness programs available.

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

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