# Utilization Management Nurse Consultant

**Company**: CVS Health
**Location**: Work At Home, Alabama
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $26.01 - $56.14
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Alabama/Utilization-Management-Nurse-Consultant--Remote-_R1050984?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_c983c5d5-301

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Utilization Management Nurse Consultant utilises 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.

**Responsibilities**

- Gathers clinical information and applies clinical criteria, guidelines, policies and procedures to render coverage determinations and recommendations along the continuum of care.

- Communicates with providers and other parties to facilitate care and treatment.

- Identifies members for referral opportunities to integrate with other products, services and programmes.

- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilisation.

- Consults and lends expertise to internal and external constituents in the coordination and administration of the utilisation/benefit management function.

- Works in a typical office environment with productivity and quality expectations.

- Performs close inspection of handwritten and computer-generated documents and PC monitors.

- Sedentary work involving periods of sitting, talking and listening.

- Requires sitting for extended periods, talking on the telephone and typing on the computer.

- Ability to multitask, prioritise and adapt to a fast-paced changing environment.

- Proficiency with computer skills, including navigating multiple systems and keyboarding.

- Effective communication skills, both verbal and written.

**Requirements**

- 2+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care setting.

- Active current and unrestricted RN licensure in state of residence.

**Preferred Qualifications**

- 3+ years of clinical experience in adult med surg or specialty area.

- Managed Care experience preferred, especially Utilisation Management.

- Preference for those residing in CST zone.

**Education**

- Associate or Bachelor of Science in Nursing (BSN preferred).

**Work from Home Requirements**

- Direct/hardwired internet connection to a modem/router within 7 feet of computer and minimum download speed of 25 Mbps download and 3 Mbps upload.

- Quiet, secure and private designated home virtual work location, free from distractions, tidy and organised, compliant with CVSHealth and HIPAA guidelines.

- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

- The company will provide equipment (keyboard, monitor, computer, headset, etc.).

**Technical and Logistical Requirements**

- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.

- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.

- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).

- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognise suspicious emails or links.

- Troubleshooting & Support: Ability to resolve common technical issues independently.

- Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

**Benefits** This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.

## Skills

### Required
- Registered Nurse
- Clinical Experience
- Utilisation Management
- Microsoft Office 365

### Nice to have
- Managed Care
- Adult Med Surg
- Specialty Area

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Alabama/Utilization-Management-Nurse-Consultant--Remote-_R1050984?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)