Utilization Management Nurse Consultant - Remote Work

The Muse - Little Rock, AR

Job Title: Utilization Management Nurse Consultant - Remote Work

Position: Medical Management

Job Type: Full Time

Pay: $26.01 - $74.78 per hour

Shift: Monday-Friday: 11:30am-8:00pm EST

Work Type: Remote

Location

Address:

City: Little Rock

State: AR

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 appropriate clinical criteria/guidelines 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 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 in making independent decisions
Proficient use of clinical documentation systems and equipment such as phones and computers

Preferred Skills

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

Requirements

Experience: 1 year in Utilization Management, 5 years clinical experience

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

License & Certification:

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

Schedule:

First 3 weeks on-camera training, 8:30am-5:00pm 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, 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 CVS Health bonus, commission, or short-term incentive program

Special Notes

Position requires the use of residential broadband service with specific speed requirements.

Facility Details

Name: The Muse

Description: A medical management company that is a division within Aetna/CVS Health, founded in 1993, and URAC accredited in Case Management, Disease Management, and Utilization Management.

Specialties: