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CategoryHealthcare
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No of Jobs1
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Apply Before10/03/2025
Description
Utilization Management Nurse Consultant - Remote Work
Lensa - Montgomery, AL
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Clinical Coordinator
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30am-6:00pm MST
Work Type: Remote
Location
Address:
City: Montgomery
State: AL
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 options to facilitate appropriate healthcare services/benefits for members.
- Gathers clinical information and applies appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services, and/or programs.
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Works in a clinical telephone queue with providers to secure additional information for prior authorization review.
Required Skills
Core Skills
- Clinical judgment
- Communication skills
- Ability to work in a clinical documentation system
- Independent decision-making
Preferred Skills
- Managed Care (MCO) experience
- Experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year in Utilization Management; 5 years of clinical experience required.
Education: Associate's nursing degree (RN) minimum required; bachelor's degree preferred.
License & Certification:
- Registered Nurse (RN) license in state of residence with multi-state/compact privileges
Schedule:
- First 3 weeks on-camera training with 100% participation required from 8:30am-5pm, Monday-Friday.
- Weekend/holiday coverage will occasionally be required.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- Wellness screenings
- Tobacco cessation programs
- Weight management programs
- Confidential counseling and financial coaching
- Dependent care resources
- Tuition assistance
- Retiree medical access
Supplemental Pay
- CVS Health bonus
- Commission or short-term incentive program
Special Notes
- CVS health requires eligible colleagues to use a residential broadband service with specific minimum speed for remote work.
- Verification of internet service provider necessary.
Facility Details
Name: Lensa
Description: Leading health solutions company providing care for millions of Americans.
Specialties:
- Medical Management
- Utilization Management
- Disease Management
Mission: Building a world of health around every consumer and surrounding ourselves with dedicated colleagues.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/03/2025
Posted:
07/03/2025
