Remote Utilization Management Nurse Consultant

CVS Health; Louisiana; Hybrid; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant (UMNC) for a fully remote role. You will coordinate and document utilization/benefit management, ensuring appropriate care while meeting regulatory turnaround times. You’ll review clinical records, apply criteria and support discharge planning, working with facilities and providers.

Weekend/holiday rotations apply and travel is minimal. The role requires an active RN license and hospital experience.

Qualifications

• Active, current RN license in state of residence.
• 2+ years of acute hospital clinical experience as an RN (within the past 10 years).
• 1+ years of experience with Microsoft Office including PowerPoint, Excel, and Word.

Responsibilities

• Coordinate, document and communicate utilization/benefit management activities.
• Ensure the member is receiving appropriate care at the right time and location.
• Review services to assure medical necessity and apply clinical criteria.

Skills

RN license

Acute hospital RN experience

Microsoft Office

Education

Associate Degree in Nursing

Bachelor’s in Science & Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking a Utilization Management Nurse Consultant (UMNC) for a fully remote role. You will coordinate and document utilization/benefit management, ensuring appropriate care while meeting regulatory turnaround times. You’ll review clinical records, apply criteria and support discharge planning, working with facilities and providers.

Weekend/holiday rotations apply and travel is minimal. The role requires an active RN license and hospital experience.