Remote UM Nurse Consultant - Clinical Care Coordination

CVS Health Corporation; Kansas; Hybrid; USD 54,000 - 117,000; Full time

Job summary

CVS Health Corporation is seeking an experienced Utilization Management (UM) Nurse Consultant for a 100% remote, full-time role open to CST-zone residents. You will apply your clinical expertise to ensure members receive safe, effective, and appropriate care at the right time and in the right setting, reviewing clinical documentation and coordinating with providers.

The position requires an active, unrestricted RN license, ADN (BSN preferred), and 2+ years of acute hospital clinical experience,

Qualifications

• 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.

Responsibilities

• 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.

Skills

RN license

Acute hospital clinical experience

Strong clinical assessment

Effective communication

Independent work

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office (Word, Excel, PowerPoint, Outlook)

Job description

CVS Health Corporation is seeking an experienced Utilization Management (UM) Nurse Consultant for a 100% remote, full-time role open to CST-zone residents. You will apply your clinical expertise to ensure members receive safe, effective, and appropriate care at the right time and in the right setting, reviewing clinical documentation and coordinating with providers.

The position requires an active, unrestricted RN license, ADN (BSN preferred), and 2+ years of acute hospital clinical experience,