Remote Utilization Management Nurse Consultant

CVS Health; Pennsylvania; Hybrid; USD 40,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management on a work-from-home schedule with weekend coverage. You will assess, plan, implement, coordinate, monitor, and evaluate options to facilitate healthcare services and member benefits.

Responsibilities include gathering clinical information, communicating with providers, and coordinating care. Requires active RN licensure, 3+ years RN experience, and 1+ years in UM/CM, with strong communication and multitasking abilities.

Qualifications

• RN licensure active in state of residence
• 3+ years of RN experience in acute or post-acute settings
• 1+ years in Utilization Management / Care Management

Responsibilities

• Gather clinical information and apply criteria to render coverage determinations
• Communicate with providers to facilitate care and coordinate referrals
• Identify opportunities to improve quality and effectiveness of care
• Lend expertise to coordination and administration of utilization/benefit management
• Meet productivity and quality expectations set by UMNC

Skills

Verbal communication

Written communication

Multitasking

Adaptability

Computer skills

Education

Diploma RN acceptable

Associate degree/BSN preferred

Job description

CVS Health is seeking a Registered Nurse for Utilization Management on a work-from-home schedule with weekend coverage. You will assess, plan, implement, coordinate, monitor, and evaluate options to facilitate healthcare services and member benefits.

Responsibilities include gathering clinical information, communicating with providers, and coordinating care. Requires active RN licensure, 3+ years RN experience, and 1+ years in UM/CM, with strong communication and multitasking abilities.