Remote Nurse Utilization Management Consultant

CVS Health Corporation; Northern (KY); Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical benefits

Paid time off

Retirement options

Job summary

CVS Health Corporation is seeking an Utilization Management Nurse Consultant for a remote role. You will assess clinical data, apply guidelines, and determine coverage decisions to support member care and benefits.

The position requires 2+ years as an RN in adult acute/critical care with an active license. Experience in utilization management is preferred; candidates in CST zones are encouraged to apply.

Qualifications

• 2+ years of RN experience in adult acute/critical care.
• Active, unrestricted RN license in home state.
• Utilization Management experience is a plus.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations.
• Communicates with providers to facilitate care and treatment decisions.
• Identifies referral opportunities to integrate with programs and services.
• Lends expertise in utilization/benefit management and HIPAA-compliant processes.

Skills

RN clinical experience

Utilization Management

Communication skills

HIPAA compliance

Education

ADN/BSN

Job description

CVS Health Corporation is seeking an Utilization Management Nurse Consultant for a remote role. You will assess clinical data, apply guidelines, and determine coverage decisions to support member care and benefits.

The position requires 2+ years as an RN in adult acute/critical care with an active license. Experience in utilization management is preferred; candidates in CST zones are encouraged to apply.