Utilization Management Nurse Consultant

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

📋 Description

• Oversee, document, and communicate all facets of the utilization and benefit management program for plan sponsors.

• Ensure that members receive the right care at the right time and location based on established criteria.

• Evaluate both written and electronic clinical records.

• Assess services to confirm medical necessity.

• Utilize clinical expertise to ensure appropriate benefit usage.

• Support safe and effective discharge planning.

• Collaborate closely with facilities and providers to address complex member needs.

• Comply with federal and state mandated turnaround times.

⛳️ Requirements

• Must possess an active, current, and unrestricted RN license in the state of residence.

• A minimum of 3 years of clinical experience in an acute hospital setting as an RN is required.

• Capability to operate a computer station with multiple screens, manage several programs simultaneously, and sit for extended durations.

• A designated private workspace that is distraction-free, along with high-speed internet access.

• Must be willing and able to work Monday through Friday from 8 AM to 5 PM EST, with occasional weekend on-call and holiday rotations.

• Strong customer service skills, including attentiveness to customers, sensitivity to various issues, and proactive identification and resolution of concerns.

• Proficient in Microsoft Office applications, including PowerPoint, Excel, and Word.

• Excellent telephonic communication abilities.

• At least 1 year of experience in Utilization Review.

• A minimum of 1 year of experience in Managed Care.

• An Associate’s Degree is required.

• A BSN is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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