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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 - Honolulu, HI
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Medical Management
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST
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 healthcare services/benefits for members.
- Gathers clinical information and applies appropriate clinical criteria/guideline to render coverage determinations.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services, and programs.
- Promotes quality effectiveness of healthcare services and benefit utilization.
- Consults with other internal and external constituents in the coordination and administration of utilization/benefit management.
- Functions in a clinical telephone queue to secure additional information for prior authorization review.
Required Skills
Core Skills
- Utilization Management experience
- Clinical experience
- Clinical judgment
- Proficient use of phone and computer equipment
- 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
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:
- Monday-Friday: 11:30am-8:00pm EST
- Weekend/holiday coverage may be required
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with matching contributions
- Employee stock purchase plan
- No-cost wellness programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for CVS Health bonus, commission or short-term incentive program
Special Notes
- 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: Nation's leading health solutions company that provides healthcare services.
Specialties:
- Medical Management
- Healthcare
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
