Remote RN | Utilization Management Consultant

CVS Health; Columbus (OH); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health in Columbus, OH seeks a Registered Nurse for Utilization Management to assess, plan, implement and coordinate healthcare services for members across the continuum of care. You will apply clinical criteria and collaborate with providers to render coverage recommendations and promote quality care.

Requires 2+ years in adult acute/critical care, an active RN license in the resident state, and flexibility for evenings, weekends and holidays.

Qualifications

• Active and unrestricted RN license in their state of residence.
• 2+ years of experience as an RN in adult acute/critical care.
• Must reside in EST time zone and be available to work weekends, holidays, and evenings as required.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare options for members.
• Render coverage determinations/recommendations using clinical criteria and guidelines.
• Communicate with providers and other parties to facilitate care/treatment and promote appropriate utilization of benefits.
• Identify referral opportunities to integrate with higher-level services and programs.
• Consult with internal/external stakeholders to coordinate utilization/benefit management.
• Maintain proficiency in multiple systems and provide effective verbal and written communication.

Skills

Active RN license

RN experience

EST time zone

Education

Associates Degree in Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Office 365

Job description

CVS Health in Columbus, OH seeks a Registered Nurse for Utilization Management to assess, plan, implement and coordinate healthcare services for members across the continuum of care. You will apply clinical criteria and collaborate with providers to render coverage recommendations and promote quality care.

Requires 2+ years in adult acute/critical care, an active RN license in the resident state, and flexibility for evenings, weekends and holidays.