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 criteria.

• Collaborate with healthcare providers and interdisciplinary care teams to assist in treatment planning.

• Utilize clinical judgment to inform utilization management and prior authorization choices.

• Identify areas for enhancing quality, outcomes, and member experiences.

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

• Work schedule is Monday to Friday, from 9:00 AM to 5:30 PM in the local time zone.

• Support a 24/7 utilization management operation, with potential schedules including evenings, weekends, and holidays.

⛳️ Requirements

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

• At least 3 years of RN experience required.

• Strong clinical assessment, critical thinking, and decision-making abilities.

• Proficiency in Microsoft Office applications, including Outlook, Teams, and Excel.

• Associate Degree in Nursing (ADN) is necessary.

• Availability to work Monday to Friday, from 9:00 AM to 5:30 PM in your local time zone.

• Schedules may occasionally include evenings, weekends, and holidays based on business requirements.

• Direct wired internet connection with a minimum of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not acceptable.

• Must have a dedicated, private workspace that meets HIPAA and company security standards.

• Ability to work from the confirmed state and city of residence.

• Commitment to maintaining required internet speeds and remote work standards.

• Proficient in navigating multiple monitors and applications simultaneously.

• Comfortable using Teams, Outlook, email, calendars, and virtual meeting platforms.

• Experience with Microsoft 365 applications or similar tools is preferred.

• Capability to securely access systems, including VPNs and healthcare applications.

• Basic troubleshooting skills for resolving connectivity and application challenges.

• Willingness to learn new technologies and adapt to changing business needs.

🏝️ Benefits

• Company-provided equipment includes computer, monitor(s), keyboard, and headset.

• Medical, dental, and vision insurance coverage.

• Paid time off.

• Retirement savings options available.

• Wellness programs offered.

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

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