Remote RN Utilization Management Consultant

CVS Health; New Mexico; Hybrid; USD 36,000 - 95,000; Full time

Job summary

CVS Health is seeking a Registered Nurse to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members. You will collaborate with providers and care teams to determine coverage and identify referral opportunities as part of utilization management.

This full-time role requires active RN licensure, 2+ years in adult acute/critical care, and availability for weekends, holidays, and evenings.

Qualifications

• Active, unrestricted RN license in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Must be available to work weekends, holidays, and evenings as required by business needs.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies guidelines to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care/treatment and identify referral opportunities.
• Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consult with internal and external constituents in utilization/benefit management coordination.
• Typical office working environment with productivity and quality expectations.

Skills

Clinical assessment

Care coordination

Communication with providers

Multitasking

HIPAA compliance

Education

Associates Degree in Nursing or Nursing Diploma

Job description

CVS Health is seeking a Registered Nurse to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members. You will collaborate with providers and care teams to determine coverage and identify referral opportunities as part of utilization management.

This full-time role requires active RN licensure, 2+ years in adult acute/critical care, and availability for weekends, holidays, and evenings.