Clinical Utilization Nurse Consultant

CVS Health

United States

Remote

USD 44,000 - 94,000

Full time

5 days ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management in a 24/7 operation. The role involves reviewing clinical information to determine coverage, advocating for appropriate services, and coordinating with providers and teams. The position supports a remote/hybrid setup within the United States.

The ideal candidate has 2+ years in adult acute/critical care, an active RN license, and an associates degree (BSN preferred). Weekend/evening shifts and strong communication are essential.

Qualifications

2+ years of RN experience in adult acute/critical care.
Active, unrestricted RN license in the state of residence.
Willingness to work weekends, holidays and evenings in a 24/7 UM operation.
Associates degree required; BSN preferred.
Managed care or utilization management experience is a plus.

Responsibilities

Assess and coordinate care options to facilitate appropriate services.
Gather clinical information and apply guidelines for coverage decisions.
Communicate with providers to coordinate care and referrals.
Identify opportunities to improve quality and utilization.
Collaborate with internal/external stakeholders in UM activities.

Skills

RN experience

Adult Acute Care

RN licensure

Flexible scheduling

Education

Associates degree

BSN preferred

Tools

Microsoft Office 365

EHR systems

Job description

The ideal candidate has 2+ years in adult acute/critical care, an active RN license, and an associates degree (BSN preferred). Weekend/evening shifts and strong communication are essential.

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