Remote Utilization Management Nurse Consultant

CVS Health; Clifton (TX); Remote; USD 40,000 - 86,000; Part time

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant to assess and coordinate care for members across the continuum of care. This role requires RN licensure, 2+ years in acute/critical care, and EST/CST residency with 24/7 schedule expectations.

The position emphasizes collaboration with providers, adherence to clinical criteria, and effective communication. A BSN is preferred; remote work is supported within the state(s) of residence.

Qualifications

• Active RN license in state of residence.
• 2+ years RN experience in adult acute/critical care.
• Reside in EST or CST.
• Utilization Management is a 24/7 operation with weekend/evening hours.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care to facilitate appropriate services.
• Apply clinical criteria, guidelines, and policies to determine coverage.
• Communicate with providers to coordinate care.
• Identify referral opportunities to integrate with other programs.
• Consult with internal/external stakeholders on utilization/benefit management.
• Maintain productivity and quality in a fast-paced environment.

Skills

RN licensure

Utilization Management

Clinical communication

Multitasking

MS Office 365

Education

Associate degree

BSN preferred

Tools

EHR systems

MS Office 365

Job description

CVS Health is seeking an Utilization Management Nurse Consultant to assess and coordinate care for members across the continuum of care. This role requires RN licensure, 2+ years in acute/critical care, and EST/CST residency with 24/7 schedule expectations.

The position emphasizes collaboration with providers, adherence to clinical criteria, and effective communication. A BSN is preferred; remote work is supported within the state(s) of residence.