Remote Utilization Management Nurse Consultant

CVS Health Corporation; Columbus (OH); On-site; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Comprehensive benefits

Job summary

CVS Health Corporation in Columbus, OH is seeking an Utilization Management Nurse Consultant to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services. This 24/7 role includes weekends, holidays and evening hours, with a standard schedule Monday-Friday 8:00am-5:00pm EST as possible base expectation.

The successful candidate will gather clinical information, apply guidelines, and communicate with providers to support quality and efficient benefit

Qualifications

• 3+ years of clinical experience as a Registered Nurse in a hospital setting (adult acute/critical care).
• Active, unrestricted RN licensure in the state of residence.
• Experience with Utilization Management or similar program is preferred.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations.
• Communicates with providers to facilitate care and identify referral opportunities.
• Identifies opportunities to improve quality and utilization of healthcare services.
• Lends expertise to internal/external stakeholders in utilization management.

Skills

RN experience

Communication skills

HIPAA compliance

Education

BSN preferred

Associate or BSN in Nursing

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health Corporation in Columbus, OH is seeking an Utilization Management Nurse Consultant to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services. This 24/7 role includes weekends, holidays and evening hours, with a standard schedule Monday-Friday 8:00am-5:00pm EST as possible base expectation.

The successful candidate will gather clinical information, apply guidelines, and communicate with providers to support quality and efficient benefit