Utilization Management Nurse Consultant (Weekend)

Schedule

This is an Alternative Work Schedule weekend position requiring coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules determined in collaboration with management.

Position Summary

Utilize 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

• Gather clinical information and apply appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care
• Communicate with providers and other parties to facilitate care and treatment
• Identify members for referral opportunities to integrate with other products, services, or benefit programs
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Meet set productivity and quality expectations as established by UMNC

Required Skills and Abilities

• Effective verbal and written communication skills
• Proficiency with computer skills, including navigating multiple systems and keyboarding
• Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment
• Capacity to sit for extended periods, talk on the telephone, and type on the computer

Work Location

This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed.

Required Qualifications

• Registered Nurse
• Diploma RN acceptable; Associate degree/BSN preferred
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting
• 1+ years of Utilization Management / Care Management Experience
• Active current and unrestricted RN licensure in state of residence
• May be required to obtain additional Nursing Licenses as business needs require

Preferred Qualifications

• Utilization Management experience preferred

Pay

$29.10 – $62.32 per hour. Actual base salary offer depends on experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

This full-time position is eligible for a comprehensive benefits package including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility.