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

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

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

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

• Engage with providers and other stakeholders to facilitate care and treatment.

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

• Discover opportunities to enhance healthcare service quality and promote effective benefit utilization.

• Consult and offer expertise to both internal and external stakeholders in the coordination and administration of utilization and benefit management.

• Work Friday, Saturday, Sunday, and Monday in 10-hour shifts following approximately 4–5 months of training.

• Complete training from Monday to Friday, 8:30 a.m.–5:00 p.m. EST, with occasional holiday rotations.

⛳️ Requirements

• Over 3 years of experience as a Registered Nurse.

• Active, current, and unrestricted RN licensure in the state of residence.

• A minimum of 1 year of Med/Surg experience.

• At least 1 year of experience with Microsoft Office applications, including Outlook, Teams, and Excel.

• Willingness and capability to work Friday, Saturday, Sunday, and Monday in 10-hour shifts after approximately 4–5 months of training.

• Prior Authorization or Utilization Management experience is preferred.

• Managed care experience is preferred.

• Experience with MedCompass is preferred.

• Ambulatory surgery experience is preferred.

• An Associate’s degree is required.

• A BSN is preferred.

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer, or the ability to obtain one.

• Minimum internet speed of 25 Mbps download and 3 Mbps upload is required.

• WiFi and satellite internet connections are not permitted.

• A quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines is necessary.

• Ability to work within the state and city of residence.

• Capability to set up and utilize multiple monitors and navigate various applications simultaneously.

• Proficiency in communicating via email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to log into secure systems such as VPN and EHR portals, lock the computer when not in use, manage strong passwords, and identify suspicious emails or links.

• Skills to troubleshoot common technical issues and seek IT assistance for unresolved problems.

• Willingness to learn new workplace skills.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision 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.).

• Remote work from a designated home workspace.