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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 - Honolulu, HI
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Fully remote role in medical management
Job Type: Full Time
Pay: $26.01 - $74.78 per hour
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm MST
Work Type: Remote
Location
Address:
City: Honolulu
State: HI
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, policies, procedures, and clinical judgment to render coverage determination/recommendations.
- 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
- 1 year UM, concurrent review or prior authorization experience
- 5 years of clinical experience
- Thorough independent decision making using clinical judgment
- Proficient use of equipment including phone, computer, and clinical documentation systems
- Ability to attend training on camera with 100% participation.
Preferred Skills
- 1+ years Managed Care (MCO) experience
- 1+ years experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 5 years of clinical experience required and 1 year in UM, concurrent review or prior authorization
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred.
License & Certification:
- Registered Nurse with an unrestricted license in the state of residence, with multi-state/compact privileges.
Schedule:
- Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm MST; weekend/holiday coverage may be needed.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan including matching contributions
- Employee stock purchase plan
- 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 and other benefits depending on eligibility.
Supplemental Pay
- Eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay.
Special Notes
- CVS Health requires eligible colleagues identified as permanent work from home teleworkers to use residential broadband service with specific speed requirements.
Facility Details
Name: The Muse
Description: Leading health solutions company reaching millions of Americans.
Specialties:
- Medical Management
- Healthcare Services
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
