Remote Utilization Management Nurse Consultant

CVS Health; Atlanta (GA); On-site; USD 54,000 - 117,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement savings

Job summary

CVS Health is seeking an experienced Registered Nurse for Utilization Management in a full-time, work-from-home role within the United States. The position requires 2+ years of adult acute/critical care nursing, an active RN license, and the ability to work a 24/7 schedule including evenings, weekends, and holidays.

The role involves applying clinical criteria to determine coverage, coordinating with providers, and collaborating with internal teams to optimize care and benefit utilization.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute/critical care.
• Active, current RN licensure in state of residence.
• 24/7 utilization management schedule, including weekends/holidays/evenings.

Responsibilities

• Assess, plan, implement, coordinate and monitor healthcare services for members.
• Apply clinical criteria and guidelines to render coverage determinations.
• Communicate with providers to facilitate care and referrals.
• Collaborate with internal/external stakeholders in utilization management.

Skills

RN experience

Clinical judgment

Communication skills

Education

Associate degree

BSN preferred

Tools

Microsoft Office 365

EHR portal

Job description

CVS Health is seeking an experienced Registered Nurse for Utilization Management in a full-time, work-from-home role within the United States. The position requires 2+ years of adult acute/critical care nursing, an active RN license, and the ability to work a 24/7 schedule including evenings, weekends, and holidays.

The role involves applying clinical criteria to determine coverage, coordinating with providers, and collaborating with internal teams to optimize care and benefit utilization.