Utilization Management Nurse Consultant

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

📋 Description

• Evaluate and analyze clinical data to assist in utilization and coverage decisions.

• Work together with healthcare providers, care teams, and internal collaborators to ensure suitable treatment and care strategies.

• Recognize chances for care management referrals and programs to support members.

• Advocate for high-quality, cost-efficient healthcare results.

• Act as a clinical resource for utilization and benefits management processes.

• Engage with providers while applying evidence-based criteria and clinical expertise.

• Facilitate effective, high-quality healthcare services for members.

• Operate in a remote or office environment with significant use of computers and telephones.

• Manage multiple systems and multitask within a sedentary desk role.

⛳️ Requirements

• Valid, unrestricted RN license in the state of residence.

• Minimum of 2 years of RN experience in adult acute care or critical care environments.

• Excellent clinical assessment, communication, and computer proficiency.

• Capacity to excel in a fast-paced, highly collaborative setting.

• Associate's Degree in Nursing.

• Preferred: Over 2 years of Med-Surg or specialty clinical experience.

• Preferred: Experience in Managed Care and/or Utilization Management.

• Preferred: Candidates located in Eastern time zones.

• Preferred: Bachelor of Science in Nursing (BSN).

• Must have or be able to secure a direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• A 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 home workspace that complies with CVS Health and HIPAA standards is necessary.

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

• Ability to navigate multiple monitors and applications at the same time.

• Skills in utilizing digital communication tools, including email, calendar invites, Teams messaging, and virtual meetings.

• Familiarity with Microsoft Office 365 applications or equivalent Google Workspace tools.

• Competency in logging into secure systems such as VPN and EHR portals.

• Capable of locking computer screens, managing strong passwords, and identifying suspicious emails or links.

• Ability to troubleshoot common technical issues independently.

• Willingness to learn new skills as the work environment evolves.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program alongside base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off for personal use.

• Retirement savings options available.

• Access to wellness programs.

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

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