Utilization Management Nurse Consultant – EST

This is a fully remote position, open to applicants in Connecticut, +9 more states.

📋 Description

• Evaluate, strategize, implement, coordinate, monitor, and assess options to ensure suitable healthcare services and benefits for members.

• Collect clinical data and apply clinical criteria, guidelines, policies, procedures, and professional judgment to make coverage decisions or recommendations.

• Communicate with healthcare providers and other stakeholders to facilitate care and treatment.

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

• Recognize opportunities to enhance the quality, effectiveness, and utilization of healthcare services.

• Consult with both internal and external partners regarding coordination and administration of utilization and benefit management.

• Operate in a standard office setting with expectations for productivity and quality while working remotely.

• Conduct detailed inspections of handwritten and computer-generated documents and PC monitors.

• Engage in sedentary work involving extended periods of sitting, telephone communication, and typing on a computer.

⛳️ Requirements

• Applicants must reside in EST time zones.

• Must hold an active and unrestricted Registered Nurse (RN) license in the state of residence.

• A minimum of 2 years of experience as a Registered Nurse in adult acute care or critical care settings is required.

• Must be available to work weekends, holidays, and evening hours as needed.

• An Associate's Degree in Nursing is a mandatory requirement.

• A direct/hardwired internet connection to a modem/router within 7 feet of the computer is necessary.

• Minimum internet speeds of 25 Mbps download and 3 Mbps upload are required.

• A quiet, secure, and private designated home workspace that complies with CVS Health and HIPAA guidelines is essential.

• The ability to work within the state and city of current residence is required.

• Proficiency in computer usage, including various systems and keyboarding skills, is essential.

• Effective verbal and written communication skills are required.

• Ability to closely inspect handwritten and computer-generated documents as well as PC monitors is needed.

• Capability to sit for long durations, engage in telephone conversations, type, multitask, prioritize, and adjust to a fast-paced, changing environment is essential.

• Comfort with setting up and using multiple monitors while navigating various applications is required.

• Proficiency in using email, calendar invites, Teams messaging, and virtual meeting platforms is necessary.

• Experience with Microsoft Office 365 applications or similar tools like Google Workspace is required.

• Ability to access secure systems such as VPN and EHR portals, manage strong passwords, and identify suspicious emails or links is essential.

• Capability to troubleshoot common technical issues independently is required.

🏝️ Benefits

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

• Medical coverage provided.

• Dental coverage included.

• Vision coverage offered.

• Paid time off available.

• Retirement savings options provided.

• Access to wellness programs.

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

• Opportunity for remote work from home.

• Company-provided equipment including keyboard, monitor, computer, and headset.