Utilization Management Nurse Consultant

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

📋 Description

• Assess clinical data and utilize evidence-based criteria to provide recommendations for utilization and coverage.

• Collaborate with healthcare providers and teams to enhance treatment plans and care coordination.

• Recognize opportunities for improving the quality of healthcare, patient outcomes, and benefit utilization.

• Direct members to additional programs and services that address their healthcare requirements.

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

• Be available to work evenings, weekends, and holidays, as schedules may require covering a 24/7 operation.

⛳️ Requirements

• Possess an active, unrestricted RN license in your state of residence.

• Have a minimum of 2 years of RN experience in an adult acute care or critical care environment.

• Exhibit strong communication, critical thinking, and multitasking abilities.

• Demonstrate proficiency in navigating various computer systems.

• Hold an Associate’s Degree in Nursing (required).

• Preferably, have over 2 years of Med-Surg or specialty clinical experience.

• Experience in Managed Care and/or Utilization Management is preferred.

• Candidates residing in Central or Eastern time zones are preferred.

• BSN is preferred.

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

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

• WiFi and satellite internet connections are not permitted.

• A quiet, secure, and private designated home virtual workspace must comply with CVS Health and HIPAA guidelines.

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

• Must provide your own workspace furniture, such as a desk or standing desk.

• Comfortable setting up and using multiple monitors and navigating several applications simultaneously.

• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.

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

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

• Ability to lock your computer screen when unattended, manage strong passwords, and identify suspicious emails or links.

• Capacity to resolve common technical issues independently and contact IT for unresolved matters.

• Willingness to learn new skills as the workplace environment continues to evolve.

🏝️ Benefits

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

• 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 (keyboard, monitor, computer, headset, etc.).