Remote RN Utilization Consultant — Drive Care Quality

4004 Aetna Medicaid Administrators; Oklahoma; Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health in Oklahoma is seeking an experienced Utilization Management Nurse Consultant (RN) for a 100% remote role based in Oklahoma. You will review medical necessity, coordinate care, support discharge planning and provide coverage recommendations, collaborating with providers and care teams.

The ideal candidate holds an active RN license in Oklahoma, at least 2 years of acute care RN experience, and an associate degree (BSN preferred).

Qualifications

• Active, unrestricted RN license in Oklahoma.
• Minimum 2 years of acute care hospital RN experience.
• Associate Degree in Nursing; BSN preferred.

Responsibilities

• Review clinical information and authorize services based on criteria and guidelines.
• Assess medical necessity and appropriate benefit utilization.
• Coordinate care and support safe, efficient discharge planning.
• Communicate with providers and healthcare teams to facilitate treatment plans.
• Identify opportunities for care management and quality improvement.
• Document and manage utilization review activities throughout the continuum of care.

Skills

RN license Oklahoma

Acute care RN experience

Strong communication

Critical thinking

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office

EHR systems

Job description

CVS Health in Oklahoma is seeking an experienced Utilization Management Nurse Consultant (RN) for a 100% remote role based in Oklahoma. You will review medical necessity, coordinate care, support discharge planning and provide coverage recommendations, collaborating with providers and care teams.

The ideal candidate holds an active RN license in Oklahoma, at least 2 years of acute care RN experience, and an associate degree (BSN preferred).