Utilization Management Nurse Consultant

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

📋 Description

• Evaluate and analyze clinical information to assist in coverage decisions and care coordination.

• Utilize clinical guidelines, policies, and professional judgment for utilization management choices.

• Work in partnership with providers and interdisciplinary teams to ensure suitable treatment and services.

• Recognize opportunities for care management referrals and member support initiatives.

• Advocate for quality, cost-effective healthcare delivery and benefit utilization.

• Offer utilization management expertise and assistance to both internal and external stakeholders.

• Operate in a remote office setting adhering to productivity and quality performance standards.

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

⛳️ Requirements

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

• At least 2 years of RN experience in an adult acute care or critical care environment.

• Associate Degree in Nursing (ADN) is required.

• Strong communication, multitasking, and computer skills are essential.

• 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.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, and private designated home virtual work environment in compliance with CVS Health and HIPAA guidelines is mandatory.

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

• A personal workspace with furniture, such as a desk or standing desk, is required.

• Comfortable with setting up and using multiple monitors and navigating various applications simultaneously.

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

• Experience with Microsoft Office 365 applications or equivalent Google Workspace applications is preferred.

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

• Must be able to adhere to computer security protocols, including locking screens, managing strong passwords, and identifying suspicious emails or links.

• Ability to independently troubleshoot common technical issues and contact IT for unresolved problems.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental insurance included.

• Vision insurance coverage.

• Paid time off is provided.

• Options for retirement savings are available.

• Wellness programs to support health and well-being.

• Additional resources to promote physical, emotional, and financial wellness.

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