Remote Utilization Management Nurse Consultant

CVS Health; Kansas City (MO); 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

Job summary

CVS Health is seeking an experienced Registered Nurse to join the Utilization Management team in a remote role. You will review clinical information, apply evidence-based criteria, and collaborate with providers to ensure appropriate, high-quality care and benefits for members.

The role requires an active RN license, ADN, and at least two years in adult acute or critical care. Strong communication and computer skills are essential for success in a fast-paced, remote environment.

Qualifications

• Active, unrestricted RN license in your state of residence.
• Minimum 2 years of RN experience in an adult acute care or critical care setting.
• Associate Degree in Nursing (ADN).
• Strong communication, multitasking, and computer skills.

Responsibilities

• Review clinical information to support coverage determinations and care coordination.
• Apply evidence-based criteria and clinical guidelines to utilization decisions.
• Collaborate with providers and interdisciplinary teams to facilitate appropriate care.
• Identify opportunities for care management referrals and member support programs.
• Promote cost-effective healthcare delivery and benefit utilization.

Skills

Active RN license

RN experience 2+ yrs

Communication

Computer skills

Education

Associate Degree in Nursing (ADN)

Tools

EHR portal

MS Office 365

Job description

CVS Health is seeking an experienced Registered Nurse to join the Utilization Management team in a remote role. You will review clinical information, apply evidence-based criteria, and collaborate with providers to ensure appropriate, high-quality care and benefits for members.

The role requires an active RN license, ADN, and at least two years in adult acute or critical care. Strong communication and computer skills are essential for success in a fast-paced, remote environment.