Utilization Management Nurse Consultant

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

📋 Description

• Assess clinical data and apply evidence-based guidelines to determine coverage and authorization decisions.

• Collaborate with healthcare providers, physicians, and interdisciplinary teams to enhance patient outcomes.

• Recognize opportunities for care coordination, case management, and other healthcare initiatives.

• Advocate for effective healthcare utilization and prioritize member-centered care.

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

• Operate in a technology-driven environment utilizing various systems and documentation platforms.

• Promote patient advocacy, critical thinking, healthcare decision-making, quality assurance, outcomes, and member experiences.

⛳️ Requirements

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

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

• Associate Degree in Nursing (ADN) is required.

• Preference for candidates located in the Eastern Time Zone.

• Preferred experience includes 2+ years in Med-Surg or specialty clinical roles.

• Experience in Utilization Management or Managed Care is a plus.

• Bachelor of Science in Nursing (BSN) is preferred.

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

• Minimum internet speed requirements are 25 Mbps download and 3 Mbps upload.

• Must have a quiet, secure, and private home workspace that complies with CVS Health and HIPAA regulations.

• Flexibility to work evenings, weekends, and holidays as needed in a 24/7 operational environment.

• Ability to navigate multiple screens, applications, systems, and documentation platforms efficiently.

• Proficient in using email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Knowledge of computer security protocols, including screen locking, strong password management, and identifying suspicious emails or links.

• Aptitude for independently resolving common technical issues.

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

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

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental coverage provided.

• Vision coverage included.

• Paid time off available.

• Retirement savings options to secure your future.

• Access to wellness programs.

• Company-provided equipment (keyboard, monitor, computer, headset, etc.) for your work needs.

• A robust benefits package promoting physical, emotional, and financial well-being.