Remote RN Utilization Management Consultant

CVS Health Corporation; Arizona; Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement plan

Job summary

CVS Health Corporation is seeking a remote Utilization Management Nurse Consultant. This RN role requires an unrestricted license and 2+ years of acute care experience.

You will coordinate and document UM activities, review medical necessity, and collaborate with providers to optimize patient outcomes while working 40 hours weekly. Working hours are standard, with the potential for occasional schedule adjustments.

Qualifications

• RN with active and unrestricted state license.
• Strong communication and telephonic skills.
• Experience with utilization management or case coordination is preferred.
• Proficient with Microsoft Office Suite and basic computer navigation.

Responsibilities

• Coordinate, document and communicate utilization/benefit management activities.
• Conduct utilization reviews to assess medical necessity and appropriateness of services.
• Collaborate with providers, payers and care teams to optimize patient outcomes.
• Explain and apply clinical criteria and guidelines to render coverage determinations.

Skills

Critical thinking

Communication skills

Problem solving

Telephonic communication

Independent judgement

Time management

Education

RN license

Tools

MS Office

Electronic Health Records

Job description

CVS Health Corporation is seeking a remote Utilization Management Nurse Consultant. This RN role requires an unrestricted license and 2+ years of acute care experience.

You will coordinate and document UM activities, review medical necessity, and collaborate with providers to optimize patient outcomes while working 40 hours weekly. Working hours are standard, with the potential for occasional schedule adjustments.