Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical information and utilize evidence-based guidelines, policies, and clinical judgment to facilitate coverage decisions.

• Coordinate, assess, monitor, and evaluate healthcare services across the entire care continuum.

• Partner with providers and care teams to ensure appropriate treatment and care planning.

• Identify opportunities to enhance quality of care, improve member outcomes, and optimize healthcare utilization.

• Connect members with additional programs, services, and resources when necessary.

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

• Work remotely in a computer-centric role with expectations for productivity and quality.

• Frequently collaborate with providers, members, and interdisciplinary healthcare teams.

• Be prepared to work schedules that may include evenings, weekends, and holidays, as Utilization Management operates around the clock.

⛳️ Requirements

• Must possess an active, 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 clinical assessment, critical thinking, and communication abilities are essential.

• Capability to multitask and perform efficiently in a fast-paced environment.

• Proficiency in navigating various computer systems and applications is required.

• An Associate Degree in Nursing is mandatory.

• Preference for candidates with 2+ years of Med-Surg or specialty nursing experience.

• Prior experience in Managed Care or Utilization Management is preferred.

• Residence in the Central Time Zone is preferred.

• A BSN is preferred.

• Willingness to work schedules that may include evenings, weekends, and holidays.

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

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

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

• Must work within the state and city where you currently reside.

• Ability to provide necessary workspace furniture, such as a desk or standing desk.

• Capability to use multiple monitors and applications concurrently.

• Proficiency in communication through email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Must follow computer, password, and security practices.

• Ability to independently resolve common technical issues.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off benefits.

• Retirement savings options available.

• Access to wellness programs.

• Additional resources to support the physical, emotional, and financial well-being of colleagues and their families.

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

• Opportunity for remote work from home.

• Collaborative clinical team environment.

• Potential for career advancement in Utilization Management and Managed Care.