Remote Florida RN Utilization Management Nurse Consultant

CVS Health; United States; A distancia; USD 40.000 - 86.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Descripción de la vacante

CVS Health is seeking an Utilization Management Nurse Consultant who must reside in Florida. This remote, full-time role reviews clinical information to ensure appropriate care, applies medical necessity criteria, and coordinates utilization management with providers and care teams.

The position requires an active Florida RN license and at least 3 years of inpatient nursing experience. Travel is not required, but state licensing expansion may be sponsored where needed.

Formación

• Active, unrestricted RN license in Florida.
• Minimum of 3 years of inpatient nursing experience.
• Willingness to obtain additional state licenses as needed (company-sponsored).
• Must permanently reside in Florida.
• Strong clinical assessment, documentation, communication, and critical-thinking skills.

Responsabilidades

• Review clinical documentation and apply medical necessity criteria to make coverage determinations.
• Coordinate and communicate utilization and benefit management across care continuum.
• Collaborate with providers and interdisciplinary teams for appropriate treatment plans and transitions.
• Use clinical judgment to support evidence-based care and resource utilization.
• Identify members who may benefit from care management and facilitate referrals.

Conocimientos

RN license Florida

Inpatient nursing

Clinical assessment

Communication

Critical thinking

Educación

ADN

BSN (preferred)

Descripción del empleo

CVS Health is seeking an Utilization Management Nurse Consultant who must reside in Florida. This remote, full-time role reviews clinical information to ensure appropriate care, applies medical necessity criteria, and coordinates utilization management with providers and care teams.

The position requires an active Florida RN license and at least 3 years of inpatient nursing experience. Travel is not required, but state licensing expansion may be sponsored where needed.