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 members receive appropriate healthcare services and benefits.

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

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

• Recognize members for referral possibilities involving additional products, services, or programs.

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

• Consult and provide expertise to both internal and external parties in the coordination and management of utilization and benefits.

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

• Conduct thorough reviews of handwritten and computer-generated documents and PC displays.

• Remain seated for extended durations, engage in phone conversations, and type on a computer.

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

⛳️ Requirements

• A minimum of 2 years of clinical experience as a Registered Nurse in a hospital environment focusing on adult acute care or critical care.

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

• Availability to work weekends, holidays, and evening shifts in a 24/7 operational setting.

• Proficiency in computer skills, including navigating multiple systems and keyboarding.

• Strong verbal and written communication abilities.

• Direct/hardwired internet connection to a modem/router located 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 home virtual workspace that complies with CVSHealth and HIPAA standards.

• Must reside and work in the state and city of current residence.

• Capability to furnish workspace furniture, such as a desk or standing desk.

• Ability to achieve required internet speeds and adhere to Work From Home protocols.

• Comfortable using multiple monitors and navigating various applications simultaneously.

• Proficiency in using email, calendar invites, Teams messaging, and participating in virtual meetings.

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

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

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

• Ability to independently resolve common technical issues and contact IT when needed.

• An Associate or Bachelor of Science in Nursing (BSN preferred).

🏝️ 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.).

• Comprehensive benefits package for eligible full-time colleagues.