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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 - Dover, DE
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Clinical Utilization Management Nurse
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: Dover
State: DE
ZIP Code:
Job Responsibilities
- Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
- Employs clinical experience to assess, plan, implement, coordinate, monitor, and evaluate options for appropriate healthcare services/benefits.
- Gathers clinical information and applies the relevant clinical criteria/guideline, policy, procedure, and clinical judgment to make coverage determinations.
- Communicates with providers and other parties to facilitate care and treatment.
- Identifies members for referral opportunities to integrate with other products, services and/or programs.
- Promotes quality effectiveness of healthcare services and benefit utilization.
- Consults with other internal and external parties 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 experience
- Effective communication skills
- Proficient use of clinical documentation systems
Preferred Skills
- Managed Care (MCO) experience
- Experience in a high-volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year in 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 unrestricted license in their state of residence with multi-state/compact privileges
Schedule:
- Requires occasional weekend/holiday coverage
- First 3 weeks of training require 100% participation on camera
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with 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 and flexible work schedules
- Family leave and 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
- CVS Health fosters a workplace where every colleague feels valued and that they belong.
- 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 with a local presence and digital channels.
Specialties:
- Medical management
- Healthcare solutions
Mission: To care for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.
Job Info
