Utilization Management Nurse Consultant – Weekends

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

📋 Description

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

• Collect clinical data and apply relevant clinical criteria, guidelines, policies, procedures, and clinical judgment for making coverage decisions or recommendations.

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

• Identify members eligible for referral opportunities by integrating various products, services, and programs.

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

• Consult with and offer expertise to both internal and external parties in managing and administering utilization and benefit management.

• Operate within a 24/7 utilization management framework, including evenings and holidays.

⛳️ Requirements

• Minimum of 3 years of experience as a Registered Nurse.

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

• At least 1 year of experience in Med/Surg.

• A minimum of 1 year of experience with Microsoft Office applications (Outlook, Teams, Excel).

• Willingness and ability to work 10-hour shifts on Saturday, Sunday, Monday, and Tuesday after approximately 4–5 months of training.

• Availability to work occasional holiday rotations.

• An Associate's degree is required.

• Experience in Prior Authorization or Utilization Management is preferred.

• Managed care experience is preferred.

• Familiarity with MedCompass is preferred.

• Ambulatory surgery experience is preferred.

• Medicare experience is essential.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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