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Utilization Management Nurse Consultant
CVS Health Careers. Review and assess clinical information to support coverage determinations and recommendations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment and evidence-based criteria application to support coverage determinations, while effectively collaborating with interdisciplinary teams to enhance member outcomes. Proficient in navigating healthcare technology and maintaining compliance with HIPAA guidelines in a remote work environment.
Highest-signal resume keywords
Active RN LicenseUtilization Management ExperienceCritical Care ExperienceMicrosoft Office 365 ProficiencyStrong Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AssessmentEvidence-Based Criteria ApplicationCare CoordinationQuality Improvement IdentificationComputer NavigationTroubleshooting Technical IssuesEHR Portal ManagementVPN LoginMulti-Monitor SetupEmail and Calendar Management
Soft Skills
Critical ThinkingAbility to Manage Multiple PrioritiesOpenness to LearningCollaborationAdaptability
Tools & Technologies
Microsoft Office 365Google WorkspaceTeams MessagingVirtual Meeting PlatformsSecure Systems
Certifications & Qualifications
Active RN LicenseAssociates Degree in NursingBSN Preferred
Industry Keywords
Managed CareMed-Surg ExperienceAcute CareCritical CareHIPAA ComplianceHealthcare Resource UtilizationQuality OutcomesInterdisciplinary TeamsRemote WorkEastern Time Zone Preference
About the role
Key responsibilities & impact- Review and assess clinical information to support coverage determinations and recommendations
- Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care
- Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes
- Identify opportunities for quality improvement, care integration, and effective benefit utilization
- Serve as a clinical resource for internal and external stakeholders
- Work remotely while leveraging clinical expertise to influence quality outcomes and healthcare resource utilization
Requirements
What you’ll need- Active, unrestricted RN license in your state of residence
- Minimum 2 years of RN experience in an adult acute care or critical care setting
- Associates degree in nursing
- 2+ years of Med-Surg or specialty clinical experience (preferred)
- Utilization Management and/or Managed Care experience (preferred)
- Strong communication, critical thinking, and computer navigation skills (preferred)
- Ability to thrive in a fast-paced environment and manage multiple priorities (preferred)
- Candidates located in the Eastern Time Zone are strongly preferred
- BSN preferred
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted
- Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
- Ability to work within the state and city where the candidate currently lives
- Ability to provide workspace furniture, such as a desk or standing desk
- Comfort setting up and using multiple monitors and navigating multiple applications
- Ability to use email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace applications
- Ability to log in to secure systems such as VPN and EHR portals, lock screens, manage strong passwords, and recognize suspicious emails or links
- Ability to troubleshoot common technical issues and contact IT when needed
- Openness to learning new skills as the workplace evolves
- Availability for schedules that may include evenings, weekends, and holidays in a 24/7 operation
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Remote work
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- CVS Health bonus, commission or short-term incentive program in addition to base pay