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 make recommendations for coverage.

• Work in collaboration with providers and interdisciplinary teams to enhance member care.

• Recognize opportunities to enhance healthcare quality, outcomes, and benefit utilization.

• Facilitate referrals to additional programs and services that cater to member needs.

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

• Assist Utilization Management operations in a dynamic, team-oriented environment.

• Integrate patient advocacy, care coordination, and healthcare decision support to ensure members receive suitable care.

⛳️ Requirements

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

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

• Excellent clinical judgment, communication, and multitasking abilities.

• Competence in working effectively across various computer systems in a productivity-centric environment.

• Associate’s Degree in Nursing required.

• Preference for candidates residing in the Eastern Time Zone.

• Prior experience in Utilization Management or Managed Care is preferred.

• BSN is preferred.

• Availability to work evenings, weekends, and holidays as required by the schedule.

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

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

• WiFi and satellite internet connections are not acceptable.

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

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

• Capability to utilize multiple monitors and manage various applications simultaneously.

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

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

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

• Knowledge of computer security practices, including screen locking, strong password management, and recognizing suspicious emails or links.

• Skill in troubleshooting common technical issues independently.

• Willingness to acquire new skills as the workplace evolves.

🏝️ 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 promoting physical, emotional, and financial well-being.

• Company-provided equipment (keyboard, monitor, computer, headset, etc.).

• Opportunity for remote work from home.