Remote RN Utilization Management Consultant

CVS Health; Ohio; Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs and other resources

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This remote role requires an RN with acute care background and Ohio residency.

Responsibilities include coordinating care, applying clinical criteria for coverage, communicating with providers, and identifying referral opportunities to integrate with other services. Strong documentation and HIPAA compliance are essential.

Qualifications

• Associates Degree in Nursing required, BSN preferred.
• 2+ years RN experience in adult acute/critical care.
• 2+ years clinical experience in med-surg or specialty area.
• Managed Care or Utilization Management experience preferred.
• Active RN license in resident state required.

Responsibilities

• Utilize clinical experience to assess and coordinate healthcare services for members.
• Gather clinical information to apply appropriate clinical criteria for coverage determination.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents on utilization management.
• Navigate multiple systems and applications to streamline tasks.
• Communicate via digital channels including email and virtual meetings.
• Resolve common technical issues independently.
• Maintain a quiet and secure home work environment compliant with CVS Health and HIPAA guidelines.

Skills

Nursing

Acute care

Utilization Management

Communication

Education

Associate's Degree in Nursing

BSN preferred

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This remote role requires an RN with acute care background and Ohio residency.

Responsibilities include coordinating care, applying clinical criteria for coverage, communicating with providers, and identifying referral opportunities to integrate with other services. Strong documentation and HIPAA compliance are essential.