Remote RN Utilization Management Consultant

CVS Health; Lorida (FL); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is hiring a registered nurse to assess, plan, implement, coordinate, monitor and evaluate options for healthcare services and member benefits. The role requires applying clinical criteria to determine coverage and coordinating with providers to support care across the continuum.

Strong communication and HIPAA-compliant processes are essential. Ideal candidates hold an active RN license, with 2+ years in adult acute/critical care, and must be available for weekends, holidays, and

Qualifications

• Active and unrestricted RN license in the candidate's state of residence.
• Minimum 2 years of RN experience in adult acute/critical care.
• Availability to work weekends, holidays, and evenings as required.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare services/benefits for members.
• Apply clinical criteria and guidelines to render coverage determinations.
• Coordinate with providers to facilitate care and identify referral opportunities.
• Lend expertise to coordination and administration of utilization/benefit management.

Skills

RN license

2+ years RN experience

weekends/evenings availability

Education

Associates Degree in Nursing

Bachelors Degree in Nursing

Job description

CVS Health is hiring a registered nurse to assess, plan, implement, coordinate, monitor and evaluate options for healthcare services and member benefits. The role requires applying clinical criteria to determine coverage and coordinating with providers to support care across the continuum.

Strong communication and HIPAA-compliant processes are essential. Ideal candidates hold an active RN license, with 2+ years in adult acute/critical care, and must be available for weekends, holidays, and