Remote Utilization Management Nurse Consultant

CVS Health

Lake Michigan Beach (MI)

Remote

USD 36,000 - 86,000

Full time

6 days ago

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Job summary

CVS Health is seeking a remote Utilization Management Nurse Consultant (Medicare) to apply clinical expertise beyond the bedside and ensure members receive the right care at the right time. You will review cases, collaborate with providers, and use evidence-based guidelines to support coverage determinations.

A 3+ year RN background including Med/Surg and an active RN license are required. This full-time role follows a Monday–Friday schedule with some holidays and evenings in the local time

Qualifications

Active RN license in state of residence.

Responsibilities

Review clinical cases and make coverage determinations using evidence-based guidelines.
Collaborate with providers and care teams to coordinate appropriate treatment.
Apply clinical judgment to support utilization and benefit management decisions.
Identify opportunities to improve care quality and member outcomes.
Serve as a clinical resource across internal and external stakeholders.

Skills

RN license

RN experience

Med/Surg

Clinical assessment

Microsoft Office

Time zone work

Associate Degree in Nursing

Education

Associate Degree in Nursing

Tools

Microsoft Office

Job description

A 3+ year RN background including Med/Surg and an active RN license are required. This full-time role follows a Monday–Friday schedule with some holidays and evenings in the local time

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