Remote Utilization Management Nurse Consultant

California Nursing Students Association Incorporated; California; Remote; USD 67,000 - 143,000; Full time

Job summary

CVS Health is hiring a Registered Nurse for Utilization Management in California. This full-time role supports a 24/7 operation with weekend, holiday and evening hours. You will assess care options, apply criteria, and coordinate referrals to ensure appropriate services for members.

The position requires 2+ years of acute/critical care nursing, an active RN license, and strong communication. A remote work setup within the state is required, with equipment provided and comprehensive benefits.

Qualifications

• 2+ years of RN experience in adult acute/critical care.
• Active, unrestricted RN license in state of residence.
• Utilization Management is a 24/7 operation with varied hours.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Gathers clinical information and applies criteria to render coverage determinations.
• Communicate with providers to facilitate care and referrals and promote proper utilization.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal/external stakeholders in the coordination of utilization/benefit management.
• Work in a typical office environment with productivity and quality expectations.
• Proficient with computers and navigating multiple systems; strong verbal and written communication.

Skills

Clinical nursing

RN licensure

Communication skills

Education

Associates Degree

BSN preferred

Job description

CVS Health is hiring a Registered Nurse for Utilization Management in California. This full-time role supports a 24/7 operation with weekend, holiday and evening hours. You will assess care options, apply criteria, and coordinate referrals to ensure appropriate services for members.

The position requires 2+ years of acute/critical care nursing, an active RN license, and strong communication. A remote work setup within the state is required, with equipment provided and comprehensive benefits.