Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and utilize evidence-based standards to guide coverage decisions

• Work collaboratively with healthcare providers and interdisciplinary teams to coordinate care and enhance outcomes

• Recognize opportunities to elevate healthcare quality, efficiency, and member satisfaction

• Link members to additional services and programs as needed

• Act as a clinical resource for utilization and benefits management processes

• Operate in a fast-paced, team-oriented remote setting with established productivity and quality benchmarks

• Engage in a 24/7 operation that requires availability during evenings, weekends, and holidays

⛳️ Requirements

• Current, unrestricted RN license in your state of residence

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

• Associate Degree in Nursing (ADN)

• Strong clinical judgment, excellent communication, and proficient computer skills

• Experience in Medical-Surgical or specialty nursing

• Background in Utilization Management or Managed Care

• Candidates must be located in the Eastern or Central Time Zone

• 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

• WiFi and satellite internet connections are not acceptable

• A quiet, secure, and private designated home virtual work location that complies with CVS Health and HIPAA regulations

• Must work within the state and city of current residence

• Ability to utilize multiple monitors and applications simultaneously

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

• Familiarity with Microsoft Office 365 applications or similar Google Workspace applications

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

• Ability to adhere to computer security practices, manage strong passwords, and identify suspicious emails or links

• Competence in troubleshooting common technical issues independently

• Willingness to learn new skills as the workplace 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 to support physical, emotional, and financial well-being

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

• Fully remote work environment

• Flexible scheduling, including evenings, weekends, and holidays