Utilization Management Nurse Consultant

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

📋 Description

• Assess clinical data and utilize evidence-based criteria to provide coverage recommendations.

• Collaborate with healthcare professionals and internal teams to ensure optimal patient outcomes.

• Identify potential areas for care coordination and member support initiatives.

• Encourage effective healthcare utilization and enhance the quality of service delivery.

• Manage various systems and priorities in a dynamic, team-oriented atmosphere.

• Assist members in navigating their healthcare experiences.

• Fulfill scheduled shifts that may involve evenings, weekends, and holidays as part of a 24/7 operation.

⛳️ Requirements

• Current, 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.

• Excellent communication, computer, and multitasking abilities.

• Willingness to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation.

• Previous experience in Managed Care and/or Utilization Management is preferred.

• Over 2 years of clinical experience in Medical-Surgical or specialty care is preferred.

• BSN is preferred.

• Candidates residing in the Central Time Zone are preferred.

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

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

• A quiet, secure, private designated home work location compliant with CVS Health and HIPAA standards is essential.

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

• Ability to use multiple monitors and navigate various applications effectively.

• Familiarity with Microsoft Office 365 or similar tools like Google Workspace is required.

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

• Ability to adhere to computer and password security protocols and recognize suspicious emails or links.

• Competence in independently troubleshooting common technical issues.

🏝️ 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 programs.

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

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