Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and utilize evidence-based guidelines to make coverage decisions.

• Collaborate with healthcare providers and care teams to enhance treatment plans and ensure continuity of care.

• Discover opportunities for care management referrals and improved healthcare utilization.

• Foster quality, efficiency, and positive outcomes for members.

• Operate in a dynamic, technology-driven environment while achieving productivity and quality targets.

• Work together with providers and healthcare teams as part of a 24/7 operation.

• Utilize digital communication tools such as email, calendar invites, Teams messaging, and virtual meetings.

• Access secure systems and uphold necessary system and workspace security protocols.

• Resolve common technical issues and reach out to IT for problems that remain unsolved.

⛳️ Requirements

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

• Minimum of 2 years of RN experience in adult acute care, critical care, or medical-surgical settings.

• Strong clinical judgment, communication, and ability to multitask effectively.

• Proficient in navigating various computer systems, monitors, and Microsoft Office applications.

• Capability to work independently in a remote setting.

• Associate degree in nursing is required.

• Experience in Utilization Management or Managed Care is preferred.

• Prior experience in case management, care coordination, or health plan operations is preferred.

• Residency in the EST time zone is preferred.

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

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

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA guidelines is essential.

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

• Competence in using multiple monitors and applications concurrently.

• Familiarity with Microsoft Office 365 applications or similar Google Workspace tools is necessary.

• Ability to utilize secure systems such as VPN and EHR portals is required.

• Strong adherence to computer security practices, including managing passwords and recognizing suspicious emails or links.

• Capability to troubleshoot common technical issues independently.

• Availability for schedules that may include evenings, weekends, and holidays is required.

• Commitment to working 40 hours per week.

🏝️ Benefits

• Fully remote position with company-provided technological equipment.

• Opportunities for professional advancement and development.

• Comprehensive medical, dental, and vision coverage.

• Paid time off benefits.

• Retirement savings options available.

• Wellness programs offered.

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

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