Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical data and utilize evidence-based criteria to support coverage decisions.

• Assess, coordinate, monitor, and evaluate healthcare services throughout the continuum of care.

• Collaborate with healthcare providers and care teams to facilitate suitable treatment plans.

• Identify chances to enhance quality, efficiency, and healthcare utilization.

• Connect members to additional programs and services as needed.

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

• Work afternoon/evening shifts as part of 24/7 operations.

• Commit to approximately 40 hours of work each week.

• Navigate various monitors, applications, secure systems, and communication tools to perform tasks efficiently.

⛳️ Requirements

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

• Have a minimum of 2 years of adult acute care and/or critical care nursing experience.

• Exhibit strong clinical assessment and decision-making abilities.

• Capable of navigating multiple computer systems and managing competing priorities.

• Excellent verbal and written communication skills are essential.

• An Associate Degree in Nursing is required.

• Willingness to work on weekends, holidays, and evening shifts.

• Must have a direct/hardwired internet connection to a modem/router within 7 feet of the computer, or the ability to obtain one.

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

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, and private designated home work location that complies with CVS Health and HIPAA guidelines is needed.

• Ability to set up and utilize multiple monitors while navigating various applications simultaneously.

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

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

• Must be able to log in to secure systems such as VPN and EHR portals.

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

• Capability to resolve common technical issues independently and contact IT when necessary.

• Openness to developing new skills as the workplace evolves.

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

• Preferred: Experience in Managed Care, especially in Utilization Management.

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

• Preferred: Residency in the Eastern Time Zone.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Remote work from home opportunities.

• Comprehensive benefits package available for full-time colleagues and their families.