Remote RN Utilization & Care Management Consultant

CVS Health; Nebraska; Hybrid; USD 54,000 - 143,000; Full time

Job summary

CVS Health is hiring a Utilization Management Nurse Consultant for a fully remote role. The position supports utilization and benefit management, ensuring appropriate care is delivered in a timely manner in alignment with regulations.

Responsibilities include reviewing records, coordinating care, and collaborating with facilities and providers to optimize member outcomes. Requires RN license, 3+ years of clinical RN experience, and availability for EST hours.

Qualifications

• Active, current, and unrestricted RN licensure in state of residence.
• Availability to work Monday–Friday 8:00am–4:30pm EST and weekend rotation.
• 3+ years of clinical RN experience.
• Proficient with Microsoft Office Suite (Teams, Outlook, Word, Excel, etc.).

Responsibilities

• Reviews services to assure medical necessity and appropriate benefit utilization.
• Coordinate, document and communicate all aspects of the utilization/benefit management program.
• Collaborate with facilities and providers to meet the complex needs of the member.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care/treatment.
• Identify referral opportunities to integrate with other products, services and/or programs.

Skills

Strong communication

Time management

Team collaboration

Education

Associate degree

BSN preferred

Tools

Microsoft Office

Job description

CVS Health is hiring a Utilization Management Nurse Consultant for a fully remote role. The position supports utilization and benefit management, ensuring appropriate care is delivered in a timely manner in alignment with regulations.

Responsibilities include reviewing records, coordinating care, and collaborating with facilities and providers to optimize member outcomes. Requires RN license, 3+ years of clinical RN experience, and availability for EST hours.