Remote Utilization Management Nurse Consultant

CVS Health; Baton Rouge (LA); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Utilization Nurse Consultant for a fully remote position. The role supports utilization/benefit management, ensuring appropriate care timing and location while following federal and state regulations.

Normal hours are Mon-Fri 8:00am-4:30pm in the residence time zone, with occasional weekend/holiday rotation and up to 10% travel for audits. The candidate will review clinical records, apply guidelines, and coordinate with facilities and providers to ensure medical necessity

Qualifications

• Must hold an active RN license in state of residence.
• 2+ years of acute hospital RN experience (recent within 10 years).
• 1+ years of Microsoft Office experience (PowerPoint, Excel, Word).
• Must be willing to work Mon-Fri 8:00am-4:30pm in the residence time zone.
• Weekend and holiday rotation as needed.

Responsibilities

• Coordinate, document and communicate all aspects of the utilization/benefit management program.
• Collaborate to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Gather clinical information and apply criteria/guidelines to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify referrals to integrate with other products and programs.
• Promote quality and effectiveness of healthcare services and utilization.
• Lend clinical expertise to internal and external stakeholders.

Skills

Active RN license

Microsoft Office

Telephonic communication

Education

Associates Degree in Nursing

Bachelor's in Science & Nursing

Job description

CVS Health is seeking a Utilization Nurse Consultant for a fully remote position. The role supports utilization/benefit management, ensuring appropriate care timing and location while following federal and state regulations.

Normal hours are Mon-Fri 8:00am-4:30pm in the residence time zone, with occasional weekend/holiday rotation and up to 10% travel for audits. The candidate will review clinical records, apply guidelines, and coordinate with facilities and providers to ensure medical necessity