Remote Utilization Management Nurse Consultant

CVS Health; New York (NY); A distancia; USD 40.000 - 86.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision coverage

Paid time off

Descripción de la vacante

CVS Health is seeking a Registered Nurse for Utilization Management in a full-time role based in the United States. The position requires a current RN license, 2+ years in adult acute/critical care, and experience with utilization management processes.

You will assess care needs, coordinate services, and render coverage determinations while communicating with providers. The role supports a 24/7 operation with schedules including weekends and evenings.

Formación

• Active RN licensure in home state.
• 2+ years RN experience in adult acute/critical care.
• Utilization Management with 24/7 requirement.
• Proficient in Microsoft Office and VPN/EHR access.
• Strong communication and documentation skills.

Responsabilidades

• Assess, plan, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Render coverage determinations/recommendations using clinical criteria and guidelines.
• Communicate with providers to facilitate care and referrals.
• Identify opportunities to promote quality and appropriate benefit utilization.
• Collaborate with internal/external stakeholders in utilization/benefit management.

Conocimientos

RN licensure

RN experience

Utilization Management

Communication skills

Multi-tasking

Educación

Associates Degree

BSN preferred

Herramientas

Microsoft Office 365

Google Workspace

EHR access

VPN security

Descripción del empleo

CVS Health is seeking a Registered Nurse for Utilization Management in a full-time role based in the United States. The position requires a current RN license, 2+ years in adult acute/critical care, and experience with utilization management processes.

You will assess care needs, coordinate services, and render coverage determinations while communicating with providers. The role supports a 24/7 operation with schedules including weekends and evenings.