Remote Utilization Management Nurse Consultant

CVS Health; Sacramento (CA); Remote; USD 44,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Dental and vision

Paid time off

Retirement options

Bonus eligibility

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management. This 24/7 role involves evaluating care options, gathering clinical information, and applying guidelines to support appropriate benefits for members.

You will collaborate with providers and internal stakeholders to coordinate care and referrals. The position requires an active RN license and 2+ years of adult acute/critical care experience, with weekend/evening coverage and a strong emphasis on accurate documentation and

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• Must have active current and unrestricted RN licensure in state of residence.
• Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
• Render coverage determinations/recommendations along the care continuum.
• Communicate with providers to facilitate care and identify referral opportunities.
• Identify opportunities to promote quality and efficiency of healthcare services and utilization.

Skills

RN experience

Clinical assessment

Communication

Team collaboration

Education

Associates Degree in Nursing

BSN preferred

Tools

EHR systems

Job description

CVS Health is seeking a Registered Nurse for Utilization Management. This 24/7 role involves evaluating care options, gathering clinical information, and applying guidelines to support appropriate benefits for members.

You will collaborate with providers and internal stakeholders to coordinate care and referrals. The position requires an active RN license and 2+ years of adult acute/critical care experience, with weekend/evening coverage and a strong emphasis on accurate documentation and