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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 - Denver, CO
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Medical Management Nurse
Job Type: Full Time
Pay: $26.01 - $74.78 per hour
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; 9:30-6:00pm MST
Work Type: Remote
Location
Address:
City: Denver
State: CO
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 the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services and/or programs.
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Functions in a clinical telephone queue working with providers to secure additional information for prior authorization review.
Required Skills
Core Skills
- Clinical judgment
- Clinical documentation
- Independent decision making
- Proficient use of phone and computer
Preferred Skills
- Managed Care experience
- Clinical call center experience
- Remote work experience
Requirements
Experience: 5 years clinical experience; 1 year UM, concurrent review or prior authorization experience
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred
License & Certification:
- Registered Nurse with an unrestricted license
Schedule:
- Full time; requires occasional weekend/holiday coverage
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
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for CVS Health bonus, commission or short-term incentive program
Special Notes
- Colleagues identified as permanent work from home teleworkers are required to use a residential broadband service meeting specified speeds.
Facility Details
Name: The Muse
Description: Nation's leading health solutions company serving millions of Americans.
Specialties:
- Medical Management
- Health Solutions
Mission: Building a world of health around every consumer.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
