Utilization Management Nurse Consultant

Position Overview

This role is a 100% position where candidates can work from any time zone provided they work CST hours (8am–5pm). The role requires working 1 major and 1 minor holiday annually. In this position, you will utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.

Key Responsibilities

• Utilize clinical experience and skills to assess, plan, implement, coordinate, monitor, and evaluate options for facilitating healthcare services and benefits for members.
• Gather clinical information and apply appropriate clinical criteria, guidelines, policies, procedures, and judgment to render coverage determinations or recommendations.
• Communicate with providers and other stakeholders to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products, services, and programs.
• Consult and lend expertise to internal and external constituents in coordinating and administering the utilization/benefit management function.

Required Qualifications

• 3 years of acute experience as a Registered Nurse.
• Must have active, current, and unrestricted RN licensure in your state of residence.
• Must be available to work Monday through Friday from 8am to 5pm CST (candidates can be located anywhere in the US).
• Must be willing to work 1 major and 1 minor holiday annually.
• Education: Associates degree required; BSN preferred.

Preferred Qualifications

• Managed Care experience preferred.

Benefits & Perks

• Compensation: Typical pay range is from $28.25 to $60.50 (base hourly rate or base annual full-time salary), with eligibility for bonus, commission, or short-term incentive programs depending on various factors.
• Medical, Dental & Vision Benefits: Enjoy a full range of healthcare benefits.
• Retirement & Investment Plans: Access to a 401(k) retirement savings plan and an Employee Stock Purchase Plan for eligible employees.
• Insurance & Disability: Fully-paid term life insurance along with short-term and long-term disability benefits.
• Time Off & Well-being: Paid Time Off (PTO), paid holidays, and various well-being, education, and development programs, including a CVS store discount and other partner discount programs.