Remote RN Utilization Management Consultant

CVS Health; Central City (KY); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking an experienced registered nurse to assess, plan, and coordinate care for members across the continuum of care. Responsibilities include applying clinical criteria to determine coverage and working with providers to facilitate treatment.

The role emphasizes collaboration with internal teams and external partners to promote high-quality, cost-effective care. A strong foundation in acute/critical care and excellent communication are essential.

Qualifications

• Active RN license in the state of residence (unrestricted).
• 2+ years of RN experience in adult acute/critical care.
• Availability to work weekends, holidays, and evenings as required by business needs.

Responsibilities

• Assess, plan, implement and coordinate care for members.
• Render coverage determinations and recommendations using clinical criteria.
• Communicate with providers to facilitate care and treatment.
• Identify opportunities to promote quality, efficiency and appropriate benefit utilization.
• Collaborate with internal/external partners in utilization management.

Skills

Active RN license

Acute/critical care

Weekend availability

Multitasking/communication

Education

Associate Degree in Nursing

Bachelor’s Degree in Nursing

Tools

EHR systems

Microsoft Office

Job description

CVS Health is seeking an experienced registered nurse to assess, plan, and coordinate care for members across the continuum of care. Responsibilities include applying clinical criteria to determine coverage and working with providers to facilitate treatment.

The role emphasizes collaboration with internal teams and external partners to promote high-quality, cost-effective care. A strong foundation in acute/critical care and excellent communication are essential.