Utilization Management Nurse Consultant

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

📋 Description

• Evaluate and analyze clinical information to formulate coverage and care recommendations.

• Implement clinical guidelines, policies, and nursing judgment throughout the continuum of care.

• Partner with providers and care teams to facilitate treatment plans.

• Recognize opportunities for care management programs and service integration.

• Advocate for quality outcomes and efficient healthcare utilization.

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

• Manage work schedules that may encompass evenings, weekends, and holidays in a 24/7 environment.

• Operate multiple monitors and applications to enhance task efficiency.

• Engage through email, calendar invites, Teams messaging, and virtual meetings.

• Access secure systems, manage passwords, and identify suspicious emails or links.

• Troubleshoot common technical issues and reach out to IT when necessary.

⛳️ Requirements

• Active, unrestricted RN license in the state of residence.

• A minimum of 2 years of RN experience in adult acute care or critical care.

• Associate's degree in Nursing.

• Proficient computer, communication, and multitasking skills.

• Capability to thrive in a fast-paced setting.

• Preferred: 2+ years of Med-Surg or 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.

• 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.

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

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

• Comfort with setting up and using multiple monitors and navigating various applications.

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

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

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

• Ability to lock computer screens, manage strong passwords, and identify suspicious emails or links.

• Ability to independently troubleshoot common technical issues.

• Willingness to learn new skills as the workplace evolves.

• Must supply own workspace furniture.

🏝️ 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 to support physical, emotional, and financial well-being.

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