Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical information and implement established guidelines, policies, and clinical judgment to assist in coverage determinations.

• Analyze, coordinate, monitor, and assess healthcare services and benefits throughout the continuum of care.

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

• Identify areas for improvement in the quality of care, health outcomes, and benefit utilization.

• Connect members with additional programs and resources that cater to their healthcare needs.

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

• Operate within a remote, computer-based Utilization Management environment.

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

• Be prepared for work schedules that may include evenings, weekends, and holidays in a 24/7 operation.

⛳️ Requirements

• Hold an active, unrestricted RN license in your state of residence.

• Possess 2+ years of experience in adult acute care and/or critical care nursing.

• Demonstrate strong clinical assessment, critical thinking, and communication abilities.

• Exhibit the capability to multitask and excel in a fast-paced environment.

• Be proficient in navigating various computer systems and applications.

• Have an Associate Degree in Nursing as a minimum educational requirement.

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

• Maintain a minimum internet speed of 25 Mbps download and 3 Mbps upload.

• Note that WiFi and satellite internet connections are not acceptable.

• Establish a quiet, secure, and private designated workspace at home that complies with CVS Health and HIPAA guidelines.

• Work must be conducted within the state and city of current residence.

• Demonstrate the ability to use multiple monitors and navigate various applications simultaneously.

• Communicate effectively through email, calendar invites, Teams messaging, and virtual meetings.

• Have experience with Microsoft Office 365 applications or comparable Google Workspace tools.

• Be capable of logging into secure systems such as VPN and EHR portals.

• Follow computer security best practices, manage strong passwords, and identify suspicious emails or links.

• Resolve common technical issues independently.

• Show openness to acquiring new skills as the workplace environment evolves.

🏝️ Benefits

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

• Receive medical coverage.

• Obtain dental coverage.

• Access vision coverage.

• Enjoy paid time off.

• Benefit from retirement savings options.

• Engage in wellness programs.

• Access additional resources supporting physical, emotional, and financial well-being.

• Receive company-provided equipment including a keyboard, monitor, computer, and headset.

• Work remotely from home.