Remote RN Utilization Management Consultant

CVS Health Corporation; Town of Florida (NY); Hybrid; USD 54,000 - 143,000; Full time

Job summary

CVS Health is seeking a fully remote Utilization Management Nurse Consultant. This role requires an RN license and 2+ years of acute hospital RN experience. You will coordinate, document, and communicate UM activities while ensuring appropriate care and timely outcomes for members.

The position emphasizes collaboration with providers, payers, and internal teams, with standard weekday hours and no travel. Remote work enables service across the United States.

Qualifications

• RN with active and unrestricted state licensure.
• 2+ years of acute hospital clinical experience as an RN.
• Preferred: Utilization Review, Managed Care, strong telephonic communication, MS Office experience.

Responsibilities

• Drives utilization management practices to ensure cost-effective care.
• Reviews medical records to determine medical necessity.
• Collaborates with providers and payers to coordinate care.
• Communicates with stakeholders to ensure optimal patient outcomes.
• Provides coaching and guidance on utilization management principles.

Skills

RN license

Telephonic skills

Microsoft Office

Clinical coordination

Problem solving

Tools

Microsoft Office Suite

Job description

CVS Health is seeking a fully remote Utilization Management Nurse Consultant. This role requires an RN license and 2+ years of acute hospital RN experience. You will coordinate, document, and communicate UM activities while ensuring appropriate care and timely outcomes for members.

The position emphasizes collaboration with providers, payers, and internal teams, with standard weekday hours and no travel. Remote work enables service across the United States.