Utilization Management, Nurse Consultant

This is a fully remote position, open to applicants in New Jersey, +4 more states.

📋 Description

• Evaluate, design, implement, coordinate, monitor, and assess options to ensure suitable healthcare services and benefits for members.

• Collect clinical information and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage decisions or suggestions.

• Liaise with providers and other stakeholders to support care and treatment.

• Identify members eligible for referral opportunities for other products, services, and programs.

• Recognize chances to enhance the quality effectiveness of healthcare services and benefit usage.

• Offer consultation and expertise to both internal and external parties in managing and administering utilization and benefit management.

• Operate in a 24/7 environment, including weekends, holidays, and evening shifts.

• Conduct thorough reviews of handwritten and computer-generated documents as well as PC monitors.

• Remain seated for prolonged periods, engage in telephone conversations, and type on a computer.

• Manage multiple tasks, prioritize effectively, and adjust to a fast-paced, evolving environment.

⛳️ Requirements

• Minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care environment.

• Current and unrestricted RN licensure in the state of residence is required.

• Availability to work on weekends, holidays, and evening shifts.

• Capability to set up and utilize multiple monitors and navigate various applications simultaneously.

• Proficient in communication via email, calendar invitations, Teams messaging, and virtual meetings.

• Familiarity with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar applications (Google Workspace).

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

• Competence in managing strong passwords and identifying suspicious emails or links.

• Capacity to independently resolve common technical issues.

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

• Minimum internet speed of 50 Mbps download and 5 Mbps upload.

• Designated home work location that is quiet, secure, and compliant with CVS Health and HIPAA guidelines.

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

• An Associate's Degree is required.

• Managed Care experience is preferred, particularly in Utilization Management.

• At least 2 years of clinical experience in medical-surgical or specialty areas.

• Preference will be given to candidates residing in Eastern zones.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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