Utilization Management Nurse Consultant

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

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess options to ensure members receive appropriate healthcare services and benefits.

• Collect clinical information and utilize clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations or recommendations.

• Engage with providers and other stakeholders to facilitate care and treatment.

• Identify members for referral opportunities related to other products, services, or programs.

• Recognize opportunities to enhance the quality of healthcare services and effective utilization of benefits.

• Collaborate with and provide expertise to both internal and external stakeholders in the coordination and administration of utilization and benefit management.

• Operate in a typical office environment with expectations for productivity and quality.

• Conduct detailed reviews of handwritten and computer-generated documents as well as PC monitors.

• Remain seated for extended periods, engage in telephone conversations, and type on a computer.

• Manage multiple tasks, set priorities, and adapt efficiently to a fast-paced and changing environment.

⛳️ Requirements

• A minimum of 2 years of clinical experience as a Registered Nurse in a hospital environment, specifically in adult acute care or critical care.

• An active, current, and unrestricted RN license in your state of residence.

• Availability to work weekends, holidays, and evening shifts as part of a 24/7 operation.

• Proficiency in computer skills, including the ability to navigate multiple systems and keyboard effectively.

• Strong verbal and written communication skills.

• An Associate or Bachelor of Science in Nursing; a BSN is preferred.

• 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.

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

• The capability to work within the state and city of your current residence.

• Proficiency in utilizing multiple monitors and applications simultaneously.

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

• Familiarity with Microsoft Office 365 applications or similar Google Workspace tools.

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

• Ability to adhere to computer and password security practices and recognize suspicious emails or links.

• Competence in troubleshooting common technical issues independently.

• Willingness to learn new skills.

• Preferred: 3+ years of clinical experience in adult medical-surgical or specialty areas.

• Managed Care experience is preferred, particularly in Utilization Management.

• Preference given to candidates residing in the CST time zone.

🏝️ 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 to support physical, emotional, and financial well-being.

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