Utilization Management Nurse Consultant

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

📋 Description

• Evaluate and analyze clinical information to provide recommendations for coverage and care.

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

• Work collaboratively with providers and care teams to enhance 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.

• Participate in a 24/7 operation, with potential schedules including evenings, weekends, and holidays.

• Assist Utilization Management by reviewing clinical information, coordinating care, and ensuring that members receive suitable, high-quality healthcare services.

⛳️ Requirements

• An active, unrestricted RN license in the state of residence is required.

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

• An Associate's degree in Nursing is required.

• Proficient computer, communication, and multitasking skills are essential.

• Ability to thrive in a fast-paced environment is necessary.

• Work schedule may include evenings, weekends, and holidays.

• Must possess or be able to establish a direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• A 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 workspace at home that complies with CVS Health and HIPAA guidelines is needed.

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

• Proficiency in using multiple monitors and navigating various applications is required.

• Ability to use email, calendar invites, Teams messaging, and participate in virtual meetings is necessary.

• Familiarity with Microsoft Office 365 applications or comparable Google Workspace tools is preferred.

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

• Must adhere to computer and password security practices and be able to identify suspicious emails or links.

• Ability to independently troubleshoot common technical issues is expected.

• Preferred: 2+ years of experience in Med-Surg or specialty clinical fields.

• Preferred: Experience in Utilization Management and/or Managed Care.

• Preferred: A 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 base salary.

• Comprehensive medical coverage.

• Dental coverage options.

• Vision coverage available.

• Paid time off provided.

• Retirement savings options available.

• Access to wellness programs.

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

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