Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical information and utilize evidence-based criteria to provide coverage recommendations

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

• Recognize opportunities for improving quality, patient outcomes, and healthcare resource utilization

• Direct members to suitable programs and services that cater to their healthcare requirements

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

• Assist a 24/7 Utilization Management team

• Ensure that members receive appropriate care at the right time

⛳️ Requirements

• Current, unrestricted RN license in your state of residence

• Minimum of 2 years of RN experience in an adult acute care or critical care environment

• Associate Degree in Nursing (ADN) required

• Excellent communication, multitasking, and computer skills

• Flexibility to work various schedules, including evenings, weekends, and holidays

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

• Minimum internet speeds of 25 Mbps download and 3 Mbps upload

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

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

• Capability to use multiple monitors and navigate various applications at the same time

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

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

• Ability to log into secure systems, such as VPN and EHR portals

• Competence in maintaining computer security, managing strong passwords, and identifying suspicious emails or links

• Skill in troubleshooting common technical issues independently

• BSN preferred

• Over 2 years of Med-Surg or specialty clinical experience preferred

• Experience in Utilization Management and/or Managed Care preferred

• Candidates from the Eastern Time Zone preferred

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary

• Medical insurance coverage

• Dental insurance coverage

• Vision insurance coverage

• Paid time off

• Options for retirement savings

• Wellness programs

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

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

• Opportunities for professional growth and skill development