Utilization Management Nurse Consultant - Remote Work

Lensa - Phoenix, AZ

Job Title: Utilization Management Nurse Consultant - Remote Work

Position: Remote Utilization Review Nurse

Job Type: Full Time

Pay: $26.01 - $74.78

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

Work Type: Remote

Location

Address:

City: Phoenix

State: AZ

ZIP Code:

Job Responsibilities

Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
Use clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determinations/recommendations.
Communicate with providers and other parties to facilitate care/treatment.
Identify members for referral opportunities to integrate with other products, services, and/or programs.
Identify opportunities to 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
Utilization management skills
Communication skills
Ability to assess and evaluate healthcare services

Preferred Skills

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

Requirements

Experience: 1 year of UM, concurrent review or prior authorization; 5 years of clinical experience required; 5 years of demonstrated ability to make thorough independent decisions using clinical judgement; 5 years of proficient use of equipment including phone and clinical documentation systems.

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

License & Certification:

Registered Nurse license required, unrestricted in state of residence
Ability to be licensed in all non-compact states

Schedule:

First 3 weeks on-camera training required 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
Wellness screenings programs
Tobacco cessation and 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 a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range

Special Notes

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting or hiring based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.