Utilization Management Nurse Consultant
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Job Description
Utilization Management Nurse Consultant reviewing clinical information for CVS Health members. Coordinating care and supporting quality healthcare decisions remotely from Pennsylvania.
Responsibilities:
- Review and assess clinical information to make coverage and care recommendations
- Apply clinical guidelines, policies, and nursing judgment across the continuum of care
- Collaborate with providers and care teams to support treatment plans
- Identify opportunities for care management programs and service integration
- Promote quality outcomes and effective healthcare utilization
- Serve as a clinical resource for internal and external stakeholders
- Work schedules that may include evenings, weekends, and holidays in a 24/7 operation
- Navigate multiple monitors and applications to streamline tasks and improve efficiency
- Communicate through email, calendar invites, Teams messaging, and virtual meetings
- Log in to secure systems, manage passwords, and recognize suspicious emails or links
- Resolve common technical issues and contact IT when needed
Requirements:
- Active, unrestricted RN license in state of residence
- 2+ years of RN experience in adult acute care or critical care
- Associate's degree in Nursing
- Strong computer, communication, and multitasking skills
- Ability to work in a fast-paced environment
- Preferred: 2+ years of Med-Surg or specialty clinical experience
- Preferred: Utilization Management and/or Managed Care experience
- Preferred: BSN
- Preferred: Residence in the Eastern Time Zone
- 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
- Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
- Ability to work within the state and city of confirmed residence
- Comfort setting up and using multiple monitors and navigating multiple applications
- 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 access secure systems such as VPN and EHR portals
- Ability to lock computer screens, manage strong passwords, and recognize suspicious emails or links
- Ability to troubleshoot common technical issues independently
- Openness to learning new skills as the workplace evolves
- Must provide own workspace furniture
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
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