Utilization Management Nurse Consultant

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

📋 Description

• Assess clinical data and utilize evidence-based guidelines to formulate coverage recommendations and decisions.

• Collaborate with healthcare providers and teams to ensure proper care and treatment delivery.

• Recognize opportunities for care management, quality enhancement, and member support initiatives.

• Offer clinical insights to both internal and external stakeholders regarding utilization and benefits management processes.

• Navigate various systems while handling a dynamic, collaborative workload.

• Review cases, assess medical necessity, coordinate care, and assist members in obtaining suitable healthcare services and benefits.

⛳️ Requirements

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

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

• Associate Degree in Nursing is mandatory.

• Excellent communication, organizational, and multitasking abilities.

• Willingness to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation.

• Preferred: 2+ years of Med Surg or other specialty clinical experience.

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

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

• Preferred: Residency in the Eastern Time Zone.

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

• Minimum internet speed requirement of 25 Mbps download and 3 Mbps upload.

• Designated home workspace that is quiet, secure, and private, compliant with CVS Health and HIPAA standards.

• Proficient in setting up and utilizing multiple monitors and navigating various applications concurrently.

• Competence in communicating through email, calendar invitations, Teams messaging, and virtual meetings.

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

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

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

• Ability to independently resolve common technical issues and reach out to IT for more complex 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 coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Opportunity for remote work from home.