Utilization Management Nurse Consultant

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

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess options to ensure suitable healthcare services and benefits.

• Collect clinical information and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage decisions or recommendations.

• Liaise with providers and other stakeholders to facilitate care and treatment.

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

• Discover opportunities to enhance the quality and efficiency of healthcare services and benefit usage.

• Consult with and offer expertise to internal and external stakeholders regarding utilization and benefit management.

• Maintain a schedule that includes weekdays, weekends, holidays, and evening hours within a 24/7 utilization management operation.

• Conduct work in a home office environment while meeting productivity and quality standards.

• Review handwritten and computer-generated documents along with computer monitors.

• Remain seated for long periods, communicate via telephone, type, and navigate multiple computer systems.

⛳️ Requirements

• A minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care environment.

• Active, current, and unrestricted RN license in the state of residence.

• Associate's Degree is mandatory.

• At least 2 years of clinical experience in medical-surgical or a specialized area.

• Preference for candidates with Managed Care experience, particularly in Utilization Management.

• Preference for individuals residing in CST time zones.

• Proficient in setting up and using multiple monitors and navigating various applications concurrently.

• Strong communication skills via email, calendar invites, Teams messaging, and virtual meetings.

• Familiarity with Microsoft Office 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or equivalent Google Workspace applications.

• Competent in logging into secure systems such as VPN and EHR portals, securing computers, managing strong passwords, and identifying suspicious emails or links.

• Capable of independently troubleshooting common technical issues.

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

• Minimum internet speed of 50 Mbps download and 5 Mbps upload.

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

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

• Ability to meet required internet speeds and comply with all work-from-home regulations.

• Excellent verbal and written communication skills.

• Proficient in computer skills, including keyboarding, multitasking, prioritization, and adaptability.

🏝️ Benefits

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

• 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 (keyboard, monitor, computer, headset, etc.).

• Opportunity for remote work from home.