Remote Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; Illinois; Hybrid; USD 67,000 - 143,000; Full time

Benefits offered by this job

Medical, dental, vision

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking an experienced Utilization Management Nurse Consultant to apply clinical judgment and guidelines to determine appropriate benefits across the continuum of care. This full-time role supports a 24/7 operation, with scheduled weekends, holidays and evening hours, and requires a quiet, private home workspace.

You will gather information, communicate with providers, and coordinate referrals while promoting quality and efficient use of healthcare services.

Qualifications

• 2+ years of clinical RN experience in adult acute/critical care.
• Active, unrestricted RN license in state of residence.
• Utilization Management is a 24/7 operation and work schedules will include weekends, holidays and evening hours.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations across the care continuum.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other programs.
• Identifies opportunities to promote the quality and effectiveness of healthcare services and benefit utilization.

Skills

RN clinical experience

Clinical documentation

Communication

Utilization management

Education

BSN preferred

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health is seeking an experienced Utilization Management Nurse Consultant to apply clinical judgment and guidelines to determine appropriate benefits across the continuum of care. This full-time role supports a 24/7 operation, with scheduled weekends, holidays and evening hours, and requires a quiet, private home workspace.

You will gather information, communicate with providers, and coordinate referrals while promoting quality and efficient use of healthcare services.