Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and utilize evidence-based guidelines to make coverage determinations.

• Partner with physicians, providers, and care teams to manage treatment and services effectively.

• Spot opportunities to enhance quality, outcomes, and the use of healthcare resources.

• Assist members by referring them to additional programs and services when suitable.

• Take part in a dynamic, team-focused environment dedicated to providing outstanding care.

• Work schedules may involve evenings, weekends, and holidays in a 24/7 operational setting.

⛳️ Requirements

• Current, unrestricted RN license in your state of residence.

• A minimum of 2 years of recent RN experience in adult acute or critical care settings.

• An Associate Degree in Nursing is mandatory.

• Experience in Medical-Surgical (Med-Surg) nursing or another specialty area is preferred.

• Previous experience in Utilization Management or Managed Care is an advantage.

• Strong clinical assessment, critical thinking, and communication abilities are essential.

• Proficient in navigating multiple computer systems and managing competing priorities.

• Preference for candidates residing in the Central Time Zone or Mountain Time Zone.

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

• Minimum internet speed of 25 Mbps for downloads and 3 Mbps for uploads.

• WiFi and satellite internet connections are not accepted.

• A quiet, secure, and private home workspace that complies with CVS Health and HIPAA regulations is necessary.

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

• Must provide personal workspace furniture.

• Comfortable using multiple monitors and managing various applications concurrently.

• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Adherence to computer security practices, including strong password management and recognizing suspicious emails or links.

• Ability to independently troubleshoot common technical issues.

• Willingness to learn new skills.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that promote physical, emotional, and financial well-being.

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

• Opportunities for professional growth.