Remote RN: Utilization Management Nurse Consultant

CVS Health Corporation; Topeka (KS); Híbrido; USD 36 000 - 77 000; Tempo integral

Resumo da oferta

CVS Health Corporation is seeking an experienced Utilization Management (UM) Nurse Consultant for a fully remote role open to CST-zone residents. You will coordinate, document, and communicate UM processes to ensure appropriate and timely care while meeting regulatory requirements.

The position requires an active RN license, 2+ years of acute hospital experience, and strong communication skills. Expect a 40-hour week with CST daytime hours and some on-call coverage.

Qualificações

• Active, unrestricted RN license
• 2+ years of acute hospital clinical experience
• Strong clinical assessment and decision‑making abilities
• Excellent organizational skills with the ability to manage multiple priorities
• Ability to work independently and communicate effectively via phone
• Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls

Responsabilidades

• Reviewing services for medical necessity and appropriate benefit use, facilitating efficient discharge planning, and collaborating with providers and facilities to support members with complex needs
• Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits
• Collecting and evaluating clinical information, applying clinical criteria, guidelines, policies, and judgment to make coverage determinations
• Communicating with providers and external partners to coordinate care and treatment plans
• Identifying opportunities for referrals to additional programs, services, or care solutions
• Recognizing opportunities to promote quality care delivery and effective benefit utilization
• Serving as a resource to internal and external stakeholders regarding UM processes and clinical considerations

Conhecimentos

Active RN license

Acute hospital experience

Clinical assessment

Organizational skills

Independent work

Phone communication

Documentation on calls

Formação académica

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Ferramentas

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Descrição da oferta de emprego

CVS Health Corporation is seeking an experienced Utilization Management (UM) Nurse Consultant for a fully remote role open to CST-zone residents. You will coordinate, document, and communicate UM processes to ensure appropriate and timely care while meeting regulatory requirements.

The position requires an active RN license, 2+ years of acute hospital experience, and strong communication skills. Expect a 40-hour week with CST daytime hours and some on-call coverage.