Remote Utilization Management Nurse Consultant

University of Minnesota School of Nursing; Northern (KY); Hybrid; USD 74,530,000 - 196,258,000; Full time

Job summary

CVS Health is seeking a Nurse Consultant to assess and coordinate healthcare services for members in a fully remote role. You will apply clinical criteria, gather information, and render recommendations to support appropriate care and benefits.

Requirements include 3+ years as an RN, active RN licensure, and proficiency with Microsoft Office/IT systems. Outpatient or utilization management experience is a plus; BSN preferred.

Qualifications

• 3+ years of experience as an RN.
• Active and unrestricted RN license in state of residence.
• Able to work in multiple IT platforms/systems.
• 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel).

Responsibilities

• Assess, plan, implement, coordinate and evaluate options to facilitate healthcare services for members.
• Gathers information and applies criteria and policy to render coverage determinations.
• Communicate with providers to facilitate care and identify referral opportunities.
• Consult and lend expertise to internal/external constituents in utilization/benefit management.

Skills

RN experience

IT systems experience

MS Office proficiency

Education

Associates Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Nurse Consultant to assess and coordinate healthcare services for members in a fully remote role. You will apply clinical criteria, gather information, and render recommendations to support appropriate care and benefits.

Requirements include 3+ years as an RN, active RN licensure, and proficiency with Microsoft Office/IT systems. Outpatient or utilization management experience is a plus; BSN preferred.