Remote Utilization Management Nurse Consultant

CVS Health

Colorado

Hybrid

USD 40,000 - 86,000

Full time

3 days ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for a remote, full-time role. The position supports a 24/7 operation with weekend/holiday/evening hours. Ideal candidates have RN licensure, 2+ years in adult acute/critical care, and Med-Surg or specialty experience.

Managed Care exposure is a plus. Approximately 40 hours per week, with work-from-home requirements and state-specific remote eligibility.

Qualifications

2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
Must have active current and unrestricted RN licensure in state of residence.
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
2+ years of clinical experience required in med surg or specialty area.
Managed Care experience preferred, especially Utilization Management.
Preference for those residing in PST zones.

Responsibilities

Assess, plan, implement, coordinate and evaluate care options for members.
Gather clinical information and apply guidelines to render coverage determinations.
Communicate with providers and other parties to facilitate care.
Identify referral opportunities to integrate with other products or programs.
Collaborate with internal/external stakeholders in utilization/benefit management.
Maintain readiness for 24/7 operations and after-hours coverage.