Utilization Management Nurse Consultant - Fully Remote

The Muse - Little Rock, AR

Job Title: Utilization Management Nurse Consultant - Fully Remote

Position: Clinical Nurse Coordinator

Job Type: Full Time

Pay: $26.01 - $74.78

Shift: Monday-Friday: 11:30 AM-8:00 PM EST; 8:30 AM-5:00 PM PST; or 9:30 AM-6:00 PM MST

Work Type: Remote

Location

Address:

City: Little Rock

State: AR

ZIP Code:

Job Responsibilities

Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gather clinical information and apply appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation.
Communicate with providers and other parties to facilitate care/treatment.
Identify members for referral opportunities to integrate with other products, services, and/or programs.
Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Function in a clinical telephone queue working with providers to secure additional information for prior authorization review.

Required Skills

Core Skills

Clinical judgment
Assessment and evaluation skills
Strong communication skills
Proficient use of clinical documentation systems

Preferred Skills

Experience in Managed Care (MCO)
Experience in high volume clinical call center
Remote work experience

Requirements

Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience required; 5 years of demonstrated ability to make thorough independent decisions using clinical judgment

Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred

License & Certification:

Registered Nurse with unrestricted license in the state of residence
Multi-state/compact privileges

Schedule:

Monday-Friday shift required; must attend the first 3 weeks of on-camera training

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

CVS Health bonus, commission, or short-term incentive program

Special Notes

CVS Health values diversity and is 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 all federal, state, and local laws.