Remote RN: Utilization Management Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement savings

Job summary

CVS Health is seeking a Remote Utilization Management Nurse Consultant. The role requires an RN with an active license and focuses on coordinating and documenting all aspects of the utilization/benefit management program.

You will apply clinical expertise to promote appropriate, cost-effective care and collaborate with providers and payers to optimize member outcomes. The position offers a full-time schedule, no travel, and a comprehensive benefits package.

Qualifications

• RN with active and unrestricted license.
• Experience in acute hospital settings preferred.
• Strong telephonic communication skills.
• Ability to manage multiple priorities.
• Proficient with Microsoft Office Suite.

Responsibilities

• Drives utilization management by ensuring appropriate and cost-effective allocation of healthcare resources.
• Conducts routine utilization reviews and assesses medical necessity.
• Collaborates with providers, multidisciplinary teams, and payers to optimize patient outcomes.
• Applies UM principles to influence stakeholders and networks of healthcare professionals.
• Reviews medical records and provides recommendations for care coordination and resource optimization.

Skills

Telephonic communication

Clinical decision making

Problem solving

Time management

Customer service

Education

RN License

Tools

Microsoft Office

Job description

CVS Health is seeking a Remote Utilization Management Nurse Consultant. The role requires an RN with an active license and focuses on coordinating and documenting all aspects of the utilization/benefit management program.

You will apply clinical expertise to promote appropriate, cost-effective care and collaborate with providers and payers to optimize member outcomes. The position offers a full-time schedule, no travel, and a comprehensive benefits package.