Remote Utilization Management Nurse Consultant

CVS Health; Illinois; Remote; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant to assess, plan, implement, and coordinate healthcare services for members. This remote role in Illinois lets you contribute to healthcare quality and effectiveness while staying within a remote setting.

You will bring RN licensure, an Associate's degree (BSN preferred), 2+ years in adult acute/critical care with Utilization Management experience, and strong communication with providers.

Qualifications

• Associates Degree required, BSN preferred.
• 2+ years RN experience in adult acute/critical care.
• 2+ years of clinical experience in med surg or specialty area preferred.
• Managed Care experience preferred, especially in Utilization Management.
• Active RN licensure in state of residence required.

Responsibilities

• Assess and coordinate healthcare services for members.
• Apply clinical criteria and guidelines with gathered information.
• Communicate with providers to facilitate care.
• Identify members for referral opportunities to integrate with other services.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal and external stakeholders on utilization management.
• Navigate multiple systems and applications to streamline tasks.
• Communicate effectively using digital channels and collaboration tools.
• Troubleshoot common technical issues independently.

Skills

RN experience

Clinical coordination

Communication with providers

Education

Associate degree

BSN preferred

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant to assess, plan, implement, and coordinate healthcare services for members. This remote role in Illinois lets you contribute to healthcare quality and effectiveness while staying within a remote setting.

You will bring RN licensure, an Associate's degree (BSN preferred), 2+ years in adult acute/critical care with Utilization Management experience, and strong communication with providers.