Utilization Management Nurse Consultant - Remote Work

The Muse - Boise, ID

Job Title: Utilization Management Nurse Consultant - Remote Work

Position: Clinical 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; Weekend/holiday coverage occasionally required

Work Type: Remote

Location

Address:

City: Boise

State: ID

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 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

1 year utilization management, concurrent review, or prior authorization experience
5 years clinical experience
Demonstrated ability to make thorough independent decisions using clinical judgment
Proficient use of equipment including phone, computer, etc., and clinical documentation systems

Preferred Skills

1+ years managed care experience
1+ years experience in a high volume clinical call center environment
Remote work experience

Requirements

Experience: 5 years of clinical experience; 1 year UM, concurrent review, or prior authorization

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

License & Certification:

Registered Nurse with an unrestricted license in their state of residence
Multi-state/compact privileges and ability to be licensed in all non-compact states

Schedule:

Required to attend the first 3 weeks on camera training with 100% participation

COVID-19 Requirements: Not Specified

Benefits

Affordable medical plan options
401(k) plan with company matching 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, and many other benefits depending on eligibility

Supplemental Pay

Eligible for CVS Health bonus, commission, or short-term incentive program

Special Notes

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Organizational commitment to fostering a workplace where every colleague feels valued and belongs.

Facility Details

Name: The Muse

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

Specialties: