Utilization Management Nurse Consultant

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

📋 Description

• Evaluate clinical documentation while utilizing evidence-based criteria, policies, and clinical judgment to assist in coverage decisions.

• Oversee, coordinate, monitor, and assess healthcare services throughout the care continuum.

• Partner with providers and care teams to promote effective treatment plans and care coordination.

• Spot opportunities to enhance healthcare quality, effectiveness, and benefit usage.

• Link members with programs and resources that foster positive health outcomes.

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

• Operate within a computer-based 24/7 utilization management environment.

• Frequently collaborate with providers, members, and interdisciplinary teams.

⛳️ Requirements

• Active and unrestricted RN license in your state of residence.

• A minimum of 2 years of experience in adult acute care and/or critical care nursing.

• Strong clinical assessment, critical thinking, and communication abilities.

• Capability to juggle multiple priorities in a fast-paced, technology-focused setting.

• Proficiency in navigating various computer systems.

• An Associate Degree in Nursing is required.

• Preferably 2 or more years of Med-Surg or specialty nursing experience.

• Experience in Managed Care or Utilization Management is preferred.

• Residence in the North Central Time Zone is preferred.

• A 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.

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

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA standards.

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

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

• Proficient in using email, calendar invites, Teams messaging, and virtual meetings.

• Ability to access secure systems like VPN and EHR portals.

• Skills to manage strong passwords and identify suspicious emails or links.

• Competence in troubleshooting common technical issues independently.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• Medical, dental, and vision insurance coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

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

• Remote work from home flexibility.

• Equipment provided by the company, including keyboard, monitor, computer, and headset.