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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 - Remote Work
The Muse - Atlanta, GA
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Remote Nurse for Medical Management
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; 9:30am-6:00pm MST
Work Type: Remote
Location
Address:
City: Atlanta
State: GA
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.
- Apply appropriate clinical criteria/guidelines to render coverage determinations/recommendations along the continuum of care.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products, services, 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 for prior authorization review.
Required Skills
Core Skills
- Utilization management experience
- Clinical judgment
- Proficient use of phone, computer, and clinical documentation systems
Preferred Skills
- Managed Care experience
- High volume clinical call center experience
- Remote work experience
Requirements
Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience required.
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:
- 40 hours per week, Monday-Friday, remote work
- Weekend/holiday coverage occasionally required
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan including matching 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 a CVS Health bonus, commission, or short-term incentive program
Special Notes
- Must have a residential broadband service with speeds of at least 25 mbps/3mbps.
- No wireless equipment, no satellite, no contracts, no business class lines.
Facility Details
Name: The Muse
Description: A medical management company that is a division within Aetna/CVS Health, founded in 1993 and URAC accredited.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: To deliver flexible medical management services that support cost-effective quality care for members.
Job Info
