Remote Utilization Management Nurse Consultant

CVS Health; Lansing (MI); On-site; USD 40,000 - 86,000; Full time

Job summary

CVS Health seeks an RN for Utilization Management in a fully remote role. The candidate will assess and coordinate healthcare services for members, applying clinical criteria to determine coverage and communicating with providers to facilitate treatment.

Requires 3+ years of RN experience, active RN license, and proficiency with Office 365 and multiple IT platforms. Eligible to work from home within the US and strong understanding of HIPAA guidelines.

Qualifications

• 3+ years of RN experience.
• Active and unrestricted RN license in state of residence.
• Able to work across multiple IT platforms/systems.
• 1+ years of experience with Microsoft Office apps (Outlook, Teams, Excel).
• Associates Degree in Nursing required.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services.
• Render coverage determinations using clinical criteria and guidelines.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other CVS Health programs.

Skills

RN Experience

Active RN License

IT Systems

MS Office

Education

Associates Degree in Nursing

BSN preferred

Tools

EHR Systems

Office 365

Job description

CVS Health seeks an RN for Utilization Management in a fully remote role. The candidate will assess and coordinate healthcare services for members, applying clinical criteria to determine coverage and communicating with providers to facilitate treatment.

Requires 3+ years of RN experience, active RN license, and proficiency with Office 365 and multiple IT platforms. Eligible to work from home within the US and strong understanding of HIPAA guidelines.