Remote RN Utilization Management Consultant

CVS Health Corporation; United States; Remote; 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 Corporation is seeking a Utilization Management Nurse Consultant for a 100% remote role. You will coordinate and document utilization/benefit management, ensuring appropriate care across the continuum while meeting regulatory requirements.

The position requires an RN with an active license and 2+ years of acute hospital clinical experience, with preferred UR and managed care exposure. Working hours are standard M–F with CST time zone flexibility.

Qualifications

• RN with active and unrestricted state licensure in their state of residence.
• 2+ years of acute hospital clinical experience as an RN.
• Preferred: 1+ years’ Utilization Review experience.
• Preferred: 1+ years’ experience in Managed Care.
• Strong telephonic communication skills.
• 1+ years’ experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook).

Responsibilities

• Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of healthcare resources.
• Conducts routine utilization reviews and assessments using evidence-based criteria.
• Collaborates with healthcare providers, multidisciplinary teams, and payers to develop care plans.
• Applies clinical expertise to influence stakeholders in utilization management strategies.
• Reviews medical records and documentation to ensure compliance and optimal care coordination.
• Consults with internal and external constituents in utilization/benefit management coordination.
• Communicates with providers and other parties to facilitate care and address inquiries.
• Promotes quality, cost-effectiveness of healthcare services and benefit utilization.

Skills

RN license

Acute care RN

Telephonic communication

MS Office

Utilization Review (UR)

Managed Care

Tools

PowerPoint

Word

Excel

Outlook

Job description

CVS Health Corporation is seeking a Utilization Management Nurse Consultant for a 100% remote role. You will coordinate and document utilization/benefit management, ensuring appropriate care across the continuum while meeting regulatory requirements.

The position requires an RN with an active license and 2+ years of acute hospital clinical experience, with preferred UR and managed care exposure. Working hours are standard M–F with CST time zone flexibility.