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CategoryHealthcare
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No of Jobs1
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Apply Before10/01/2025
Description
Utilization Management Nurse Consultant - Fully Remote
The Muse - Atlanta, GA
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Registered Nurse for Utilization Management
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30am-6:00pm MST
Work Type: Remote
Location
Address:
City: Atlanta
State: GA
ZIP Code:
Job Responsibilities
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Assesses, plans, implements, coordinates, monitors and evaluates options to facilitate appropriate healthcare services/benefits for members.
- Gathers clinical information and applies appropriate clinical criteria/guidelines to render coverage determinations.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services, and programs.
- Promotes quality effectiveness of healthcare services and benefit utilization.
- Consults and lends expertise to internal and external constituents in the utilization/benefit management function.
- Functions in a clinical telephone queue working with providers for prior authorization review.
Required Skills
Core Skills
- Clinical experience
- Independent decision-making using clinical judgment
- Proficient use of phone and computer equipment
- Experience with clinical documentation systems
Preferred Skills
- Managed Care experience
- Experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year in utilization management, concurrent review or prior authorization; 5 years of clinical experience required
Education: Associate's nursing degree (RN) minimum required, Bachelor's degree preferred
License & Certification:
- Unrestricted RN license in state of residence
- Multi-state/compact privileges
Schedule:
- Requires weekend/holiday coverage occasionally
- First 3 weeks of training must be attended on camera
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan including matching company contributions
- Employee stock purchase plan
- No-cost wellness screenings and tobacco cessation programs
- Confidential counseling and financial coaching
- Paid time off and flexible work schedules
- Family leave and dependent care resources
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for CVS Health bonus, commission or short-term incentive program
Special Notes
- Committed to fostering a workplace where every colleague feels valued and that they belong.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with federal, state and local laws.
Facility Details
Name: The Muse
Description: AHH is a medical management company that is a division within Aetna/CVS Health, founded in 1993.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: To deliver flexible medical management services that support cost-effective quality care for members.
Job Info
