Utilization Management Nurse Consultant

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

📋 Description

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

• Utilize evidence-based clinical criteria, policies, and professional judgment throughout the care continuum.

• Partner with providers and interdisciplinary teams to coordinate care and enhance member outcomes.

• Identify areas for quality improvement, care integration, and efficient benefit utilization.

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

• Work remotely as a member of CVS Health’s Utilization Management team.

• Function within a 24/7 service framework, which may require evening, weekend, and holiday shifts.

⛳️ Requirements

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

• At least 2 years of RN experience in an adult acute care or critical care environment.

• Associate's degree in nursing.

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

• Preferred: Experience in Utilization Management and/or Managed Care.

• Strong skills in communication, critical thinking, and computer navigation.

• Ability to excel in a fast-paced environment and handle multiple priorities.

• Strong preference for candidates located in the Eastern Time Zone.

• BSN is preferred.

• Availability to work evenings, weekends, and holidays as required by scheduling.

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

• Minimum internet speed of 25 Mbps download and 3 Mbps upload.

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

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

• Proficiency in using multiple monitors and navigating various applications.

• Competence in using email, calendar invites, Teams messaging, and conducting virtual meetings.

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

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

• Capability to manage strong passwords and identify suspicious emails or links.

• Ability to independently troubleshoot common technical issues.

• Willingness to learn new skills as the workplace continues to evolve.

🏝️ Benefits

• Remote work opportunity.

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• CVS Health bonus, commission, or short-term incentive program on top of the base pay range.