Remote RN Utilization Management Consultant

CVS Health; Kansas; Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a remote role in the Central Time zone. The position offers full-time hours (40 per week) with a schedule that includes evenings, weekends, and holidays, reflecting a 24/7 operation.

You will analyze clinical data to determine appropriate healthcare services and benefits, coordinating with providers to ensure quality care for members.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• Active current and unrestricted RN licensure in state of residence.
• Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products, services and/or programs.

Skills

RN experience

Education

Associates Degree

BSN preferred

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a remote role in the Central Time zone. The position offers full-time hours (40 per week) with a schedule that includes evenings, weekends, and holidays, reflecting a 24/7 operation.

You will analyze clinical data to determine appropriate healthcare services and benefits, coordinating with providers to ensure quality care for members.