Remote Utilization Management Nurse — Care Optimization

CVS Health; Springfield (IL); On-site; USD 44,000 - 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 is seeking a UM Nurse Consultant to support utilization management remotely. This role operates on a 4x10 schedule (Thu, Sat, Sun, Mon, 8A–7P with 1 hour lunch) and requires RN licensure with 3+ years Med Surg experience. You will assess and coordinate care, using clinical criteria to render coverage determinations and referrals as needed.

Strong IT skills and proficiency with MS Office are required. Associates degree in nursing is required; BSN preferred.

Qualifications

• 3+ years of Med Surg RN experience in hospital setting
• Active and unrestricted RN licensure in state of residence
• Able to work in multiple IT platforms/systems
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Communicate with providers and other parties to facilitate care and treatment; identify referral opportunities and integrate with other products/services.

Skills

Med Surg experience

RN licensure

IT platforms

Microsoft Office

Education

Associate degree in Nursing

BSN preferred

Job description

CVS Health is seeking a UM Nurse Consultant to support utilization management remotely. This role operates on a 4x10 schedule (Thu, Sat, Sun, Mon, 8A–7P with 1 hour lunch) and requires RN licensure with 3+ years Med Surg experience. You will assess and coordinate care, using clinical criteria to render coverage determinations and referrals as needed.

Strong IT skills and proficiency with MS Office are required. Associates degree in nursing is required; BSN preferred.