Utilization Management Nurse Consultant
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Job Description
Remote Utilization Management Nurse Consultant reviewing clinical cases and coverage recommendations for CVS Health members. Coordinating care and improving healthcare quality across a 24/7 operation.
Responsibilities:
- Review clinical information and apply evidence-based criteria to make utilization and coverage recommendations
- Collaborate with providers and healthcare teams to support appropriate treatment plans and care coordination
- Identify opportunities to improve healthcare quality, outcomes, and benefit utilization
- Refer members to additional programs and services supporting their healthcare needs
- Serve as a clinical resource for internal and external stakeholders
- Work schedules may include evenings, weekends, and holidays in a 24/7 operation
- Work from a designated home workspace and comply with Work From Home, HIPAA, internet, security, and equipment requirements
Requirements:
- Active, unrestricted RN license in your state of residence
- 2+ years of RN experience in an adult acute care or critical care setting
- Strong communication, critical thinking, and multitasking skills
- Proficiency navigating multiple computer systems
- Associates Degree in Nursing Required
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 mbs download and 3 mbs upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home virtual 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 use digital communication channels including email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace applications
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer security practices including locking screens, managing strong passwords, and recognizing suspicious emails or links
- Ability to troubleshoot common technical issues independently
- Openness to learning new skills as the workplace evolves
- Preferred: 2+ years of Med-Surg or specialty clinical experience
- Preferred: Managed Care and/or Utilization Management experience
- Preferred: candidates residing in Central or Eastern time zones
- Preferred: BSN
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program eligibility
- Company-provided equipment including keyboard, monitor, computer, and headset
- Remote work from home
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