Remote Utilization Management Nurse Consultant

CVS Health Corporation; Northern (KY); Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical benefits

Retirement options

Paid time off

Wellness programs

Job summary

CVS Health Corporation is seeking a Utilization Management Nurse Consultant for a fully remote, 100% work-from-home role in the CST zone. The position supports utilization and benefit management with a 40-hour work week, Monday–Friday, and occasional after-hours coverage as outlined.

Required RN license with 2+ years of acute hospital experience; ADN is acceptable with BSN preferred. Strong clinical assessment, communication, and organizational skills are essential.

Qualifications

• Active, unrestricted RN license.
• 2+ years of acute hospital clinical experience (medical-surgical/ICU/behavioral health or other specialty).
• Strong clinical assessment and decision-making abilities.
• Excellent organizational skills with the ability to manage multiple priorities.
• Ability to work independently and communicate effectively via phone.
• Comfort with computer-based work and documenting while on calls.

Responsibilities

• Reviewing services for medical necessity and benefit use; support discharge planning.
• Apply clinical skills to assess, plan, implement, coordinate, monitor, and evaluate care and benefits.
• Collect and evaluate clinical information; apply criteria and policies to make coverage determinations.
• Communicate with providers and external partners to coordinate care.
• Identify opportunities for referrals to additional programs or services.
• Promote quality care delivery and effective benefit utilization.
• Serve as a resource to stakeholders regarding UM processes and clinical considerations.

Skills

Clinical assessment

Decision making

Communication by phone

Organizational skills

Independent work

Education

ADN (Associate Degree in Nursing)

BSN preferred

RN license (unrestricted)

Tools

Microsoft Office

Job description

CVS Health Corporation is seeking a Utilization Management Nurse Consultant for a fully remote, 100% work-from-home role in the CST zone. The position supports utilization and benefit management with a 40-hour work week, Monday–Friday, and occasional after-hours coverage as outlined.

Required RN license with 2+ years of acute hospital experience; ADN is acceptable with BSN preferred. Strong clinical assessment, communication, and organizational skills are essential.