Utilization Management Nurse Consultant - Fully Remote

The Muse - Montgomery, AL

Job Title: Utilization Management Nurse Consultant - Fully Remote

Position: Clinical Care Coordinator

Job Type: Full Time

Pay: $26.01 - $74.78

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: Montgomery

State: AL

ZIP Code:

Job Responsibilities

Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
Applies clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies appropriate clinical criteria/guidelines, 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
Utilization management
Prior authorization processing
Clinical documentation
Effective communication

Preferred Skills

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

Requirements

Experience: 1 year of UM, concurrent review or prior authorization; 5 years of clinical experience required; 5 years of proficient equipment use experience including phone, computer, etc.

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

License & Certification:

Registered Nurse license in state of residence with multi-state/compact privileges

Schedule:

Full-time work of 40 hours per week
Mandatory training attendance for the first 3 weeks on camera, 100% participation required during 8:30am-5pm Monday-Friday

COVID-19 Requirements: Not Specified

Benefits

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings, tobacco cessation, and weight management programs at no cost
Confidential counseling and financial coaching
Paid time off and flexible work schedules
Family leave and dependent care resources
Colleague assistance programs and tuition assistance
Retiree medical access and other benefits depending on eligibility

Supplemental Pay

Eligible for CVS Health bonus, commission or short-term incentive program in addition to base pay

Special Notes

The organization values diversity and is committed to fostering an inclusive workplace.

Facility Details

Name: The Muse

Description: A medical management company that is a division within Aetna/CVS Health, founded in 1993, URAC accredited in various management services.

Specialties: