Utilization Management Nurse Consultant
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Job Description
Utilization Management Nurse Consultant reviewing clinical care and coverage for CVS Health members. Coordinating services and improving healthcare outcomes remotely from Florida.
Responsibilities:
- Review clinical information and apply guidelines, policies, and clinical judgment to support coverage determinations
- Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
- Collaborate with providers and care teams to facilitate appropriate treatment and care planning
- Identify opportunities to improve quality, effectiveness, and utilization of healthcare services
- Connect members to additional programs and resources that support positive health outcomes
- Serve as a clinical resource for internal and external stakeholders
- Work in a computer-based role with productivity and quality expectations
- Collaborate frequently with providers and interdisciplinary teams
- Participate in 24/7 Utilization Management operations, including possible evening, weekend, and holiday schedules
Requirements:
- Active, unrestricted RN license in your state of residence
- 2+ years of adult acute care and/or critical care nursing experience
- Strong clinical assessment, critical thinking, and decision-making skills
- Excellent verbal and written communication skills
- Ability to navigate multiple systems and manage competing priorities in a fast-paced environment
- Associate Degree in Nursing required
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
- Must work within the state and city where currently living
- Ability to use multiple monitors and navigate multiple applications simultaneously
- Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace tools
- Ability to log in to secure systems such as VPN and EHR portals
- Ability to maintain computer and password security and recognize suspicious emails or links
- Ability to resolve common technical issues independently
- Openness to learning new skills as the workplace evolves
- Preferred: 2+ years of Med-Surg or specialty nursing experience
- Preferred: Managed Care or Utilization Management experience
- Preferred: Residence in the Eastern or Central Time Zone
- Preferred: BSN
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment including keyboard, monitor, computer, and headset
- Remote work from home
- Supportive clinical team collaboration
- Opportunities to gain experience in Utilization Management and Managed Care
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