Clinical Nurse Utilization Management Consultant

CVS Health; Mississippi; Hybrid; USD 36,000 - 95,000; Full time

Job summary

CVS Health is seeking a registered nurse to support Utilization Management in a full-time, 24/7 operation. The role involves coordinating and evaluating care, collaborating with providers, and ensuring appropriate services for members.

The position requires 2+ years of adult acute/critical care nursing, active RN licensure, and an Associate degree (BSN preferred). The role emphasizes quality, safety, and patient-centered care within CVS Health’s comprehensive benefits program.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• Active current and unrestricted RN licensure in state of residence.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria/guidelines to render coverage determinations/recommendations across the continuum of care.
• Communicate with providers and others to facilitate care and identify referral opportunities.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal/external stakeholders in coordinating utilization/benefit management.

Skills

RN licensure

Clinical nursing experience

Education

Associate degree

BSN preferred

Job description

CVS Health is seeking a registered nurse to support Utilization Management in a full-time, 24/7 operation. The role involves coordinating and evaluating care, collaborating with providers, and ensuring appropriate services for members.

The position requires 2+ years of adult acute/critical care nursing, active RN licensure, and an Associate degree (BSN preferred). The role emphasizes quality, safety, and patient-centered care within CVS Health’s comprehensive benefits program.