Remote RN Utilization Management Consultant

Colorado Psychiatric; Colorado; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Benefits package

Paid time off

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate healthcare services for members, applying clinical judgment and guidelines to render coverage decisions. Collaboration with providers supports care pathways and program integration.

The role emphasizes quality, HIPAA compliance, and effective communication in a full-time, remote setup requiring residency in Colorado; strong computer skills are essential.

Qualifications

• Associates Degree in Nursing or Nursing Diploma required.
• Active RN license in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Able to work weekends, holidays, and evenings as needed.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care options.
• Determine coverage decisions using clinical criteria and guidelines.
• Communicate with providers to facilitate care and referrals.
• Identify opportunities to improve quality and utilization of services.
• Lend clinical expertise to coordination of utilization/benefit management.

Skills

Communication

Multitasking

Clinical judgment

Education

Associates Degree in Nursing

Nursing Diploma

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate healthcare services for members, applying clinical judgment and guidelines to render coverage decisions. Collaboration with providers supports care pathways and program integration.

The role emphasizes quality, HIPAA compliance, and effective communication in a full-time, remote setup requiring residency in Colorado; strong computer skills are essential.