Utilization Management Nurse Consultant - Fully Remote

The Muse - Juneau, AK

Job Title: Utilization Management Nurse Consultant - Fully Remote

Position: Utilization Management Nurse

Job Type: Full Time

Pay: $26.01 - $74.78 per hour

Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; 9:30-6:00pm MST

Work Type: Remote

Location

Address:

City: Juneau

State: AK

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, policy, procedure and clinical judgment to render coverage determinations or recommendations.
Communicate with providers and other parties to facilitate care and 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

Clinical judgement and decision-making
Proficient use of equipment including phone and computer
Experience with clinical documentation systems

Preferred Skills

Experience in Managed Care (MCO)
Experience working in a high-volume clinical call center
Remote work experience

Requirements

Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience required; 5 years demonstrated ability to make thorough independent decisions using clinical judgement.

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:

Weekend/holiday coverage will occasionally be required.
Must attend the first 3 weeks on-camera training, requiring 100% participation during 8:30am-5pm, Monday-Friday.

COVID-19 Requirements: Not Specified

Benefits

Affordable medical plan options
401(k) plan including matching company contributions
Employee stock purchase plan
No-cost programs including 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 in addition to base pay.

Special Notes

CVS Health fosters 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.