Utilization Management Nurse Consultant (Weekend)

CVS Health•Work At Home-Pennsylvania, PA

3d•$29 - $62•Remote

About The Position

The Utilization Management Nurse Consultant uses clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options that facilitate appropriate healthcare services and benefits for members. This is a work-from-home position. During work hours, the colleague must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at an office or client location may be required for meetings, training, or other events as directed. This alternative work schedule requires coverage on both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules are determined with management to ensure adequate weekend coverage.

Requirements

Registered Nurse.
Active, current, unrestricted RN licensure in the state of residence.
At least 3 years of experience as a Registered Nurse.
At least 1 year of clinical experience in an acute or post-acute setting.
At least 1 year of Utilization Management or Care Management experience.
Effective verbal and written communication skills.
Computer proficiency, including navigating multiple systems and keyboarding.
Ability to multitask, prioritize, and adapt effectively in a fast-paced, changing environment.
Capacity to sit for extended periods, talk on the telephone, and type on the computer.
May be required to obtain additional nursing licenses as business needs require.

Nice To Haves

Associate degree or BSN preferred; RN diploma is acceptable.
Utilization Management experience preferred.

Responsibilities

Gather clinical information and apply appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations and recommendations along the continuum of care.
Communicate with providers and other parties to facilitate care and treatment.
Identify members for referral opportunities to integrate with other products, services, or benefit programs.
Identify opportunities to promote the quality and effectiveness of healthcare services and benefit utilization.
Consult and provide expertise to internal and external constituents in coordinating and administering the utilization and benefit management function.
Meet productivity and quality expectations established by UMNC.