Remote Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; Georgia; Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Great benefits package

Job summary

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate and evaluate healthcare options for members. The role focuses on coverage determination and coordination within the utilization management framework.

The position requires an active RN license, 2+ years in adult acute/critical care, and flexibility for weekends/holidays. A strong emphasis on privacy, HIPAA compliance and collaborative care is essential.

Qualifications

• Must have an active and unrestricted RN license in the state of residence.
• Minimum 2+ years of RN experience in adult acute/critical care.
• Available to work weekends, holidays, and evenings as required.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations.
• Communicates with providers to facilitate care/treatment.
• Identifies referral opportunities to integrate with other programs.
• Supports utilization management to improve care quality and efficiency.

Skills

Clinical experience

Communication skills

Time management

Education

Associates Degree in Nursing (REQUIRED)

Bachelor's Degree in Nursing (PREFERRED)

Tools

EHR portal

Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint)

Job description

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate and evaluate healthcare options for members. The role focuses on coverage determination and coordination within the utilization management framework.

The position requires an active RN license, 2+ years in adult acute/critical care, and flexibility for weekends/holidays. A strong emphasis on privacy, HIPAA compliance and collaborative care is essential.