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CategoryHealthcare
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No of Jobs1
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Apply Before10/01/2025
Description
Utilization Management Nurse Consultant - Remote Work
The Muse - Phoenix, AZ
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Remote Clinical Manager
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm MST
Work Type: Remote
Location
Address:
City: Phoenix
State: AZ
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 for coverage determination.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services, and/or programs.
- Promotes 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
- Utilization management expertise
- Strong communication skills
Preferred Skills
- Experience in managed care (MCO)
- High volume clinical call center experience
- Remote work experience
Requirements
Experience: 1 year of 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:
- Unrestricted RN license in state of residence with multi-state/compact privileges
Schedule:
- First 3 weeks of training on camera with 100% participation required
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan including matching company contributions
- Employee stock purchase plan
- No-cost programs for wellness screenings, tobacco cessation, weight management, counseling, and financial coaching
- Paid time off, flexible work schedules, family leave, and support resources
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for CVS Health bonus, commission or short-term incentive program
Special Notes
- Commitment to fostering a workplace where every colleague feels valued and that they belong.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with federal, state, and local laws.
Facility Details
Name: The Muse
Description: A medical management company that is a division within Aetna/CVS Health, delivering flexible medical management services.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: Building a world of health around every consumer and transforming health care.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
