Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in United States, +48 more locations.

📋 Description

• Evaluate clinical cases and make coverage decisions based on evidence-based guidelines.

• Partner with providers, attending physicians, and care teams to finalize precertification requests.

• Utilize clinical judgment to assist in utilization and benefit management choices.

• Recognize opportunities to enhance care quality and improve member outcomes.

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

⛳️ Requirements

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

• Minimum of 2 years of RN experience, including at least 1 year in Med/Surg.

• Excellent clinical assessment and decision-making abilities.

• Proficient in Microsoft Office applications (Outlook, Teams, Excel).

• Availability to work Monday through Friday, from 9:00 AM to 6:00 PM in your time zone.

• Work schedules may involve holidays and evening shifts, as Utilization Management operates 24/7.

• Associate Degree in Nursing required.

• Experience in Utilization Management or Prior Authorization is preferred.

• Background in managed care is preferred.

• Experience in ambulatory surgery is preferred.

• Bachelor of Science in Nursing (BSN) is preferred.

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