Remote Utilization Management Nurse Consultant

CVS Health Corporation; Springfield (IL); Remote; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Healthcare benefits

Work-from-home

Job summary

CVS Health Corporation is seeking an Utilization Management Nurse Consultant to assess and coordinate healthcare services for members. You will review information, apply guidelines, and collaborate with providers and teams to determine coverage decisions.

The role supports 24/7 operations, including weekends and evenings, from a home-based setting. The ideal candidate holds an RN license with 2+ years of clinical experience in adult acute/critical care and has familiarity with utilization

Qualifications

• 2+ years of RN clinical experience in adult acute/critical care.
• Active RN license in state of residence.
• Ability to work weekends, holidays and evenings.
• Utilization Management experience is a plus.

Responsibilities

• Gathers clinical information and applies criteria to render coverage decisions.
• Communicates with providers to facilitate care and coordinate services.
• Identifies referrals to integrate with other programs.
• Promotes quality and appropriate utilization of healthcare services.
• Lends expertise to internal and external stakeholders in UM.

Skills

RN licensure

Adult acute/critical care

Utilization Management

Clinical coordination

Education

Associate or BSN (BSN preferred)

Tools

Microsoft Office 365

EHR portal

VPN access

Job description

CVS Health Corporation is seeking an Utilization Management Nurse Consultant to assess and coordinate healthcare services for members. You will review information, apply guidelines, and collaborate with providers and teams to determine coverage decisions.

The role supports 24/7 operations, including weekends and evenings, from a home-based setting. The ideal candidate holds an RN license with 2+ years of clinical experience in adult acute/critical care and has familiarity with utilization