Remote Utilization Management Nurse Consultant

IntelliResume; Kansas; Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs and other resources

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote position. You will review medical necessity, facilitate discharge planning, and collaborate with providers to support members with complex needs.

Qualifications include ADN required, BSN preferred, 2+ years acute hospital experience, UR/Managed Care experience, and an active RN license. The role involves coordinating care and applying clinical expertise to ensure safe, effective care and appropriate benefits

Qualifications

• 2+ years of acute hospital clinical experience (medical-surgical, ICU, behavioral health or other specialty).
• 1+ year of Utilization Review experience.
• 1+ year of Managed Care experience.
• Active, unrestricted RN license required.

Responsibilities

• Review services for medical necessity and appropriate benefit use.
• Facilitate efficient discharge planning.
• Collaborate with providers and facilities to support members with complex needs.
• Apply clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits.
• Collect and evaluate clinical information to make coverage determinations.
• Communicate with providers and external partners to coordinate care and treatment plans.
• Identify opportunities for referrals to additional programs, services, or care solutions.
• Promote quality care delivery and effective benefit utilization.

Education

Associate Degree in Nursing (ADN) required

Bachelor of Science in Nursing (BSN) preferred

Job description

CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote position. You will review medical necessity, facilitate discharge planning, and collaborate with providers to support members with complex needs.

Qualifications include ADN required, BSN preferred, 2+ years acute hospital experience, UR/Managed Care experience, and an active RN license. The role involves coordinating care and applying clinical expertise to ensure safe, effective care and appropriate benefits