Remote RN: Utilization Management Consultant

CVS Health; Hartford (CT); Remote; USD 36,000 - 103,000; Full time

Benefits offered by this job

Remote work opportunity

CVS Health bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking an experienced Registered Nurse to join the Utilization Management team in a remote capacity. In this role, you will review clinical information, apply criteria to coverage determinations, and coordinate care while collaborating with providers and care teams.

Applicants should hold an active RN license, have at least two years of acute care experience, and possess an Associate Degree in Nursing. A BSN and prior Utilization Management experience are preferred.

Qualifications

• Active RN license in good standing in your state.
• Minimum 2 years of RN experience in adult acute/critical care, med-surg, or specialty.
• Associate Degree in Nursing.

Responsibilities

• Review clinical information and apply evidence-based criteria to coverage determinations.
• Collaborate with providers, care teams, and internal partners to support quality patient care.
• Identify opportunities for care coordination and program referrals.
• Document decisions and navigate multiple systems while meeting productivity and quality goals.

Skills

Active RN license

RN experience (2+ years)

Education

Associate Degree in Nursing

Job description

CVS Health is seeking an experienced Registered Nurse to join the Utilization Management team in a remote capacity. In this role, you will review clinical information, apply criteria to coverage determinations, and coordinate care while collaborating with providers and care teams.

Applicants should hold an active RN license, have at least two years of acute care experience, and possess an Associate Degree in Nursing. A BSN and prior Utilization Management experience are preferred.