Remote Utilization Management Nurse Consultant

CVS Health; South Dakota Park (SD); À distance; USD 36 000 - 85 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision coverage

Paid time off

Retirement savings options

Résumé du poste

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) to work remotely on a full-time Weekday schedule. You will review cases, determine coverage, and collaborate with care teams to ensure appropriate treatment, while applying clinical judgment in utilization and benefit management decisions.

The role requires an active RN license, 3+ years of RN experience including 1+ year in Med/Surg, and strong assessment/decision-making skills.

Qualifications

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience, including 1+ year in Med/Surg.
• Strong clinical assessment and decision-making skills.
• Experience with Microsoft Office (Outlook, Teams, Excel).
• Associate Degree in Nursing required; BSN preferred.

Responsabilités

• Review clinical cases and make coverage determinations using evidence-based guidelines.
• Collaborate with providers and care teams to coordinate appropriate treatment.
• Apply clinical judgment to support utilization and benefit management decisions.
• Identify opportunities to improve care quality and member outcomes.
• Serve as a clinical resource across internal and external stakeholders.

Connaissances

RN license

Clinical assessment

Clinical decision-making

Microsoft Office

Time management

Utilization Management experience

Prior Authorization experience

Managed care background

MedCompass familiarity

Ambulatory surgery experience

Formation

Associate Degree in Nursing

BSN preferred

Description du poste

CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) to work remotely on a full-time Weekday schedule. You will review cases, determine coverage, and collaborate with care teams to ensure appropriate treatment, while applying clinical judgment in utilization and benefit management decisions.

The role requires an active RN license, 3+ years of RN experience including 1+ year in Med/Surg, and strong assessment/decision-making skills.