Utilization Management Nurse Consultant

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

📋 Description

• Evaluate, strategize, implement, coordinate, oversee, and assess options to ensure suitable healthcare services and benefits for members.

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

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

• Recognize members for referral opportunities to additional products, services, and programs.

• Discover opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.

• Provide consultation and expertise to both internal and external stakeholders in utilization and benefit management.

• Operate in a standard office setting with expectations for productivity and quality.

• Conduct thorough inspections of handwritten and computer-generated documents as well as PC monitor content.

• Remain seated for extended durations, communicate via telephone, and type on a computer.

• Manage multiple tasks, prioritize effectively, and adapt to a fast-paced, changing environment.

• Reach out to IT for unresolved technical issues.

⛳️ Requirements

• Must reside in the Central, Mountain, or Pacific Time zones.

• Active, current, and unrestricted Registered Nurse (RN) licensure in the state of residence.

• At least 2 years of experience as a Registered Nurse in an adult acute care or critical care setting.

• Availability to work weekends, holidays, and evening hours as necessary.

• An Associate's Degree in Nursing or a Nursing Diploma (Required).

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

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

• WiFi and satellite internet connections are not permitted.

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

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

• Proficiency in computer skills, multiple systems, keyboarding, and using multiple monitors and applications.

• Ability to utilize email, calendar invites, Teams messaging, and conduct virtual meetings.

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

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

• Competence in managing strong passwords and recognizing suspicious emails or links.

• Ability to independently resolve common technical issues.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• 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 including keyboard, monitor, computer, and headset.

• Opportunity for remote work from home.