Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and authorize services according to established criteria and guidelines.

• Determine medical necessity and ensure appropriate utilization of benefits.

• Facilitate care coordination and support safe, efficient discharge planning.

• Engage with providers and healthcare teams to streamline treatment plans.

• Spot opportunities for care management and enhancement of quality.

• Record and oversee utilization review activities across the care continuum.

• Collaborate with providers, facilities, and internal partners to guarantee quality outcomes and adherence to regulations.

• Work Monday through Friday, typically from 8:00 AM to 5:00 PM CST.

• Participate in occasional weekend on-call duties.

• Operate remotely from an Oklahoma home office with no travel necessary.

⛳️ Requirements

• Must reside in Oklahoma.

• Hold an active, unrestricted RN license in Oklahoma.

• Have a minimum of 2 years of acute care hospital RN experience.

• Possess an Associate Degree in Nursing.

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

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

• WiFi and satellite internet connections are not permitted.

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

• Ability to work within the state and city of current residence.

• Must furnish your own workspace furniture.

• Be comfortable setting up and utilizing multiple monitors and navigating various applications.

• Proficient in using digital communication channels, including email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 applications or similar Google Workspace tools.

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

• Ability to adhere to computer security protocols, including screen locking, strong password management, and identifying suspicious emails or links.

• Skillful in independently troubleshooting common technical issues.

• Willingness to learn new skills as the workplace evolves.

• BSN is preferred.

• Experience in Utilization Review and/or Utilization Management is preferred.

• Managed Care experience is preferred.

• Strong communication and critical-thinking abilities are preferred.

• Proficiency in Microsoft Office and computer-based systems is preferred.

• Capability to handle multiple priorities in a fast-paced environment is preferred.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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