Remote Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; Arkansas; Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health is hiring a Utilization Management Nurse Consultant. The role leverages clinical nursing experience to assess and coordinate healthcare services and benefits. It involves 24/7 operations with weekend, holiday, and evening hours to ensure appropriate patient care.

The candidate will gather information, apply guidelines, and communicate with providers to facilitate treatment, while identifying opportunities to improve utilization and care quality.

Qualifications

• 2+ years of clinical experience as a Registered Nurse in adult acute/critical care.
• Active RN licensure in state of residence.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations.
• Communicates with providers to facilitate care.
• Identifies referral opportunities to integrate with programs.
• Lends expertise to coordination of utilization/benefit management.

Skills

Registered Nurse experience

Critical care

Healthcare communication

Education

BSN preferred

Job description

CVS Health is hiring a Utilization Management Nurse Consultant. The role leverages clinical nursing experience to assess and coordinate healthcare services and benefits. It involves 24/7 operations with weekend, holiday, and evening hours to ensure appropriate patient care.

The candidate will gather information, apply guidelines, and communicate with providers to facilitate treatment, while identifying opportunities to improve utilization and care quality.