Remote RN Utilization Management Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Registered Nurse to assess, plan, implement, coordinate, monitor and evaluate healthcare services for members. You will render coverage determinations and recommendations using clinical criteria and collaborate with providers to facilitate care.

The role requires active RN licensure, 2+ years of adult acute/critical care experience, and availability for weekends, holidays, and evenings as needed. Strong communication and clinical judgment are essential.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum 2 years of RN experience in adult acute/critical care settings.
• Must be available to work weekends, holidays, and evening hours as required by business needs.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare services for members.
• Render coverage determinations/recommendations using clinical criteria and guidelines.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other CVS Health products and programs.
• Promote quality, effectiveness of healthcare services and benefit utilization.
• Collaborate with internal/external stakeholders in utilization/benefit management.

Skills

RN licensure

Clinical experience

Weekend/evening availability

Education

Associates Degree in Nursing or Nursing Diploma

Job description

CVS Health is hiring a Registered Nurse to assess, plan, implement, coordinate, monitor and evaluate healthcare services for members. You will render coverage determinations and recommendations using clinical criteria and collaborate with providers to facilitate care.

The role requires active RN licensure, 2+ years of adult acute/critical care experience, and availability for weekends, holidays, and evenings as needed. Strong communication and clinical judgment are essential.