Remote RN: Utilization Management Consultant

ISHE; Northern (KY); Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Utilization Management Nurse Consultant for a fully remote role with a fixed EST schedule (Mon-Fri, 8:00am–4:30pm). You will coordinate, document and communicate all aspects of the utilization/benefit management program, ensuring appropriate care, timely turn-around times, and proper location for services.

Ideal candidates hold an active RN license, have 3+ years of clinical RN experience, and are proficient with Microsoft Office.

Qualifications

• Active, current RN licensure in home state
• 3+ years of clinical RN experience
• Available to work Monday–Friday 8:00am–4:30pm EST
• Willing to rotate weekends and one holiday per year
• Proficient with Microsoft Office (Teams, Outlook, Word, Excel)

Responsibilities

• Review medical necessity and ensure appropriate benefit utilization
• Coordinate and document utilization/benefit management activities
• Collaborate with facilities and providers to meet patient needs
• Collect and assess clinical information to render coverage determinations
• Communicate with providers to facilitate care and treatment
• Identify referral opportunities to integrate with other programs
• Promote quality and effectiveness of healthcare services and utilization
• Lend expertise to internal and external stakeholders in UM/FM functions

Skills

RN licensure

Microsoft Office

Communication skills

Time management

Education

Associate degree

BSN preferred

Tools

Microsoft Office Suite

Job description

CVS Health is hiring a Utilization Management Nurse Consultant for a fully remote role with a fixed EST schedule (Mon-Fri, 8:00am–4:30pm). You will coordinate, document and communicate all aspects of the utilization/benefit management program, ensuring appropriate care, timely turn-around times, and proper location for services.

Ideal candidates hold an active RN license, have 3+ years of clinical RN experience, and are proficient with Microsoft Office.