Remote RN Utilization Management Consultant

CVS Health Corporation; Illinois; Hybrid; USD 74,528,000 - 196,424,000; Full time

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% remote role. You will coordinate, document and communicate all aspects of the utilization/benefit management program to ensure appropriate care and timely service delivery.

The ideal candidate is an RN with active licensure and 2+ years of acute hospital experience, excellent telephonic communication, and strong MS Office skills.

Qualifications

• RN with active and unrestricted state licensure in their state of residence
• 2+ years of acute hospital clinical experience as an RN
• Preferred Qualifications: Utilization Review experience, Managed Care
• Strong telephonic communication skills
• Microsoft Office Suite (PowerPoint, Word, Excel, Outlook) experience

Responsibilities

• Utilization Management practices to ensure appropriate and cost-effective allocation of healthcare resources
• Review medical necessity and appropriateness of requested services using evidence-based criteria
• Collaborate with providers and payers to develop and implement care plans
• Promote quality and cost-effectiveness of healthcare services and benefit utilization
• Coordinate and communicate all aspects of the utilization/benefit management program
• Provide coaching and guidance to staff on utilization management principles

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% remote role. You will coordinate, document and communicate all aspects of the utilization/benefit management program to ensure appropriate care and timely service delivery.

The ideal candidate is an RN with active licensure and 2+ years of acute hospital experience, excellent telephonic communication, and strong MS Office skills.