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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 - Des Moines, IA
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Nursing Position - Full Time
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: Des Moines
State: IA
ZIP Code:
Job Responsibilities
- Utilize clinical skills to coordinate, document, and communicate aspects of the utilization/benefit management program.
- Assess, plan, implement, coordinate, monitor, and evaluate options for appropriate healthcare services/benefits.
- Gather clinical information and apply clinical criteria/guidelines to render coverage determinations.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products and services.
- Promote quality effectiveness of Healthcare Services and benefit utilization.
- Consult and lend expertise to internal and external constituents in utilization/benefit management.
- Function in a clinical telephone queue to secure additional information for prior authorization review.
Required Skills
Core Skills
- Clinical judgment and decision making
- Proficient in clinical documentation systems
- Effective communication skills
- Ability to work in a high-volume clinical environment
Preferred Skills
- Experience in Managed Care (MCO)
- Experience in a clinical call center environment
- Remote work experience
Requirements
Experience: 1 year in UM, concurrent review or prior authorization; 5 years of clinical experience required.
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred.
License & Certification:
- Registered Nurse license in state of residence with multi-state/compact privileges
Schedule:
- Attendance required for the first 3 weeks of training: 8:30am-5:00pm, Monday-Friday.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with company matching contributions
- Employee stock purchase plan
- No-cost wellness screenings and programs
- Confidential counseling and financial coaching
- Flexible work schedules
- Paid time off
- Tuition assistance
- Dependent care resources
- Retiree medical access
Supplemental Pay
- Eligible for CVS Health bonus or short-term incentive program.
Special Notes
- CVS Health promotes 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 laws.
Facility Details
Name: The Muse
Description: The nation’s leading health solutions company with a local presence, digital channels, and dedicated colleagues.
Specialties:
- Utilization Management
- Medical Management
Mission: To build a world of health around every consumer.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
