Utilization Management Nurse Consultant – Weekends, 4-10 Hour Shifts

This is a fully remote position, open to applicants in Alabama, +18 more states.

📋 Description

• Evaluate and analyze clinical data to facilitate coverage decisions

• Utilize clinical guidelines, policies, and sound judgment throughout the care continuum

• Partner with providers and care teams to develop coordinated treatment strategies

• Recognize opportunities to improve quality, efficiency, and member outcomes

• Direct members to additional programs and services as needed

• Act as a clinical resource in utilization and benefit management

• Attend training sessions Monday through Friday from 8:30 AM to 5:00 PM EST

• Follow a four-day weekend work schedule from Friday to Monday with 10-hour shifts after training

• Be available for evening hours and occasional holidays as part of a 24/7 operation

⛳️ Requirements

• Current, unrestricted RN license in the state of residence

• Minimum of 3 years of RN experience

• At least 1 year of experience in Med/Surg

• Proficient in Microsoft Office (Outlook, Teams, Excel)

• Willingness to adhere to the required schedule after training

• Prior Authorization or Utilization Management experience is preferred

• Experience in managed care is preferred

• Familiarity with MedCompass is preferred

• Background in ambulatory surgery is preferred

• An Associate’s degree is required; BSN is preferred

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer, or capability to acquire one

• Minimum internet speed of 25 Mbps download and 3 Mbps upload

• A quiet, secure, and private designated home virtual workspace in compliance with CVS Health and HIPAA regulations

• Must work from the state and city of current residence

• Ability to set up and utilize multiple monitors and navigate several applications at once

• Capability to use Microsoft Office 365 applications or similar Google Workspace applications

• Ability to access secure systems such as VPN and EHR portals

• Competence in following computer security protocols, including locking screens, managing strong passwords, and identifying suspicious emails or links

• Ability to troubleshoot common technical issues and reach out to IT support when necessary

🏝️ Benefits

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

• Medical insurance coverage

• Dental insurance coverage

• Vision insurance coverage

• Paid time off

• Retirement savings options

• Wellness programs

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

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

• Opportunities for professional growth