Remote Utilization Management Nurse Consultant

CVS Health; Columbus (OH); On-site; USD 40,000 - 86,000; Full time

Job summary

CVS Health in Columbus, OH is seeking an experienced registered nurse to join Utilization Management on a 24/7 schedule. The role involves evaluating care options, coordinating benefits, and collaborating with providers to ensure appropriate services for members.

You must have an active RN license, 2+ years in adult acute/critical care, and be comfortable with steering under pressure, including weekend/evening shifts; strong communication and computer skills are required.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute/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

Responsibilities

• Assess and coordinate healthcare services and benefits for members.
• Render coverage determinations using clinical criteria and guidelines.
• Communicate with providers to facilitate care.
• Identify referral opportunities to integrate with programs.
• Collaborate with internal and external constituents in utilization/benefit management.

Skills

RN licensure

Clinical experience

Communication skills

Multitasking

Healthcare experience

Education

Associates Degree

BSN preferred

Tools

Microsoft Office 365

Teams

Outlook

Word

Excel

PowerPoint

Google Workspace

EHR portal

VPN

Job description

CVS Health in Columbus, OH is seeking an experienced registered nurse to join Utilization Management on a 24/7 schedule. The role involves evaluating care options, coordinating benefits, and collaborating with providers to ensure appropriate services for members.

You must have an active RN license, 2+ years in adult acute/critical care, and be comfortable with steering under pressure, including weekend/evening shifts; strong communication and computer skills are required.