Remote RN Utilization Management Nurse Consultant

CVS Health; Jefferson City (MO); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to join our remote team. You’ll ensure medically necessary care through clinical review and collaboration with providers in a fast-paced, desk-based environment.

Qualified applicants hold an active RN license (multistate/compact), 3+ years clinical experience, and 1+ year in Utilization Review or Medical Management. This full-time remote role offers comprehensive benefits and a competitive hourly wage.

Qualifications

• Active RN license in your state with multistate/compact privileges.
• Minimum 3 years of clinical experience.
• 5 years demonstrated ability to make independent decisions using clinical judgement.
• 5 years proficient use of equipment including phone, computer, and clinical documentation systems.
• 1+ year of Utilization Review Management/Medical Management experience.
• Must commit to a 3-week mandatory training schedule.

Responsibilities

• Utilizes clinical experience to implement, monitor, and evaluate medical review cases.
• Applies criteria to render medical determinations for clients.
• Leads reviews to authorize procedures or initiate Medical Director referrals as needed.
• Mentors and trains new nurse reviewers and vendors.

Skills

RN license

Clinical experience

Utilization

Independent decisions

Documentation systems

Education

Associate's degree in nursing

BSN preferred

Tools

Electronic health records

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to join our remote team. You’ll ensure medically necessary care through clinical review and collaboration with providers in a fast-paced, desk-based environment.

Qualified applicants hold an active RN license (multistate/compact), 3+ years clinical experience, and 1+ year in Utilization Review or Medical Management. This full-time remote role offers comprehensive benefits and a competitive hourly wage.