Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical information and utilize guidelines, policies, and clinical judgment to assist in coverage decisions.

• Coordinate, monitor, and assess healthcare services throughout the continuum of care.

• Collaborate with providers and care teams to ensure proper treatment and care planning.

• Identify areas for enhancing the quality, effectiveness, and utilization of healthcare services.

• Connect members to supplementary programs and resources that promote positive health outcomes.

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

• Engage in a computer-based role that includes productivity and quality expectations.

• Frequently collaborate with providers and interdisciplinary teams.

• Participate in 24/7 Utilization Management operations, which may include evening, weekend, and holiday shifts.

⛳️ Requirements

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

• A minimum of 2 years of experience in adult acute care and/or critical care nursing.

• Strong skills in clinical assessment, critical thinking, and decision-making.

• Excellent verbal and written communication abilities.

• Proficiency in navigating multiple systems and managing competing priorities in a fast-paced setting.

• An Associate Degree in Nursing is required.

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

• Minimum internet speed of 25 Mbps for downloads and 3 Mbps for uploads.

• WiFi and satellite internet connections are not acceptable.

• 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.

• Capability to use multiple monitors and navigate various applications simultaneously.

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

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

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

• Competence in maintaining computer and password security and recognizing suspicious emails or links.

• Ability to independently resolve common technical issues.

• Willingness to learn new skills as the workplace evolves.

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

• Preferred: Experience in Managed Care or Utilization Management.

• Preferred: Residence in the Eastern or Central Time Zone.

• Preferred: Bachelor of Science in Nursing (BSN).

🏝️ 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 initiatives.

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

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

• Remote work from home opportunity.

• Collaborative support from clinical teams.

• Opportunities to gain experience in Utilization Management and Managed Care.