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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 - Phoenix, AZ
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Clinical Nurse Reviewer
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST, 8:30am-5:00pm PST, 9:30-6:00pm MST
Work Type: Remote
Location
Address:
City: Phoenix
State: AZ
ZIP Code:
Job Responsibilities
- Utilize 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 the 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.
- 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
- Experience in Utilization Management
- Clinical experience
- Proficient use of equipment including phone, computer, and clinical documentation systems
Preferred Skills
- Experience in Managed Care (MCO)
- Experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience.
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred.
License & Certification:
- Registered Nurse with unrestricted license in state of residence
- Multi-state/compact privileges
Schedule:
- Occasional weekend/holiday coverage required
- Attending the first 3 weeks on camera training (8:30am-5pm Monday-Friday) required
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 bonuses, commission or short-term incentive program in addition to the base pay range
Special Notes
- CVS Health is committed to fostering a workplace where every colleague feels valued and belongs.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Facility Details
Name: The Muse
Description: The nation's leading health solutions company reaching millions of Americans.
Specialties:
- Medical Management
- Healthcare Services
Mission: Building a world of health around every consumer and surrounding ourselves with dedicated colleagues.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
