Remote Utilization Management Nurse Consultant

Anacalifornia; California; Remote; USD 91,722,000 - 196,258,000; Full time

Job summary

CVS Health is seeking a qualified Registered Nurse for Utilization Management to ensure appropriate healthcare services and benefits for members. This role supports a 24/7 operation, including weekends and evenings, and requires strong clinical judgment and collaboration with providers.

The position emphasizes documentation accuracy, effective communication, and the ability to work across multiple systems in a fast-paced environment.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute/critical care.
• Active RN license in the state of residence.
• Utilization Management requires 24/7 schedules including weekends, holidays, and evenings.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations.
• Collaborates with providers and internal/external parties to coordinate care.
• Identifies referral opportunities and promotes quality and utilization of healthcare services.
• Communicates effectively with stakeholders and leverages multiple systems.

Skills

Clinical assessment

Communication skills

Team collaboration

Education

Associates Degree

BSN

Job description

CVS Health is seeking a qualified Registered Nurse for Utilization Management to ensure appropriate healthcare services and benefits for members. This role supports a 24/7 operation, including weekends and evenings, and requires strong clinical judgment and collaboration with providers.

The position emphasizes documentation accuracy, effective communication, and the ability to work across multiple systems in a fast-paced environment.