Utilization Management Nurse Consultant – Weekend Shift

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

📋 Description

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

• Collect clinical data 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 involving additional products, services, and programs.

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

• Consult and provide expertise to both internal and external stakeholders in utilization and benefit management.

• Commit to two 10-hour shifts on weekends and two 10-hour shifts during weekdays.

• Achieve standard productivity and quality metrics.

• Conduct thorough inspections of handwritten and computer-generated documentation.

• Remain seated for extended durations, engage in telephone communication, type, multitask, and prioritize tasks in a dynamic environment.

⛳️ Requirements

• Willingness to work a weekend schedule: Saturday/Sunday along with two weekdays.

• Active, current, and unrestricted RN licensure in Kentucky or a multi-state compact RN license.

• A minimum of 3 years of clinical experience.

• Proficient in computer skills, including navigating multiple systems and keyboarding.

• Capability to thrive in a fast-paced work environment.

• Strong verbal and written communication abilities.

• An associate degree is mandatory.

• Previous experience in prior authorization is preferred.

• 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.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.