Utilization Management Nurse Consultant - Remote Work

The Muse - Dover, DE

Job Title: Utilization Management Nurse Consultant - Remote Work

Position: Clinical Nurse Coordinator

Job Type: Full Time

Pay: $26.01 - $74.78 per hour

Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm MST depending on the candidate's time zone; Weekend/holiday coverage may be required.

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.
Utilizes clinical experience to assess, plan, implement, coordinate, monitor and evaluate options for healthcare services.
Gathers clinical information to render coverage determination along the continuum of care.
Communicates with providers to facilitate care and treatment.
Identifies members for referral opportunities to integrate with other products and services.
Identifies opportunities to promote quality effectiveness of Healthcare Services.
Consults and lends expertise in the coordination of utilization/benefit management.
Works in a clinical telephone queue with providers for prior authorization review.

Required Skills

Core Skills

Utilization management experience
Clinical decision-making skills
Proficient in clinical documentation systems
Strong communication skills

Preferred Skills

Managed Care experience
High-volume clinical call center experience
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 with unrestricted license and multi-state/compact privileges.

Schedule:

Must attend the first 3 weeks of training on camera, 100% participation required during Monday-Friday from 8:30am-5pm.

COVID-19 Requirements: Not Specified

Benefits

Affordable medical plan options.
401(k) plan with matching contributions.
Employee stock purchase plan.
No-cost wellness programs including screenings and smoking cessation.
Paid time off and flexible work schedules.
Family leave and dependent care resources.
Tuition assistance.
Retiree medical access.

Supplemental Pay

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

Special Notes

Commitment to diversity and inclusion in the workplace.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with laws.