Remote Utilization Management Nurse Consultant

CVS Health; Texas; Remote; USD 40,000 - 85,000; Full time

Benefits offered by this job

Dental & vision

Wellness resources

Employee discounts

Voluntary benefits

Application process details

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for a remote Texas position. The role uses clinical nursing experience to assess, plan, implement and evaluate services for members, with a strong focus on utilization management and care coordination.

Ideal candidates hold an associate degree (BSN preferred) and have 2+ years in adult acute/critical care, plus managed care exposure. Active RN license in home state is required; position includes weekends, holidays, and evenings.

Qualifications

• Associate degree required; BSN preferred.
• 2+ years RN experience in adult acute/critical care.
• 2+ years clinical experience in med-surg or specialty area preferred.
• Managed Care experience, especially in Utilization Management, preferred.
• Active RN license in state of residence.

Responsibilities

• Assess and coordinate healthcare services for members.
• Gather clinical information to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services.
• Promote quality and efficiency of healthcare services and benefit utilization.
• Consult with internal/external constituents in utilization management.
• Maintain productivity and quality in a typical office environment.

Skills

Utilization management

Nursing

Care coordination

Communication

HIPAA compliance

Education

Associate degree

BSN preferred

Job description

CVS Health is seeking a Utilization Management Nurse Consultant for a remote Texas position. The role uses clinical nursing experience to assess, plan, implement and evaluate services for members, with a strong focus on utilization management and care coordination.

Ideal candidates hold an associate degree (BSN preferred) and have 2+ years in adult acute/critical care, plus managed care exposure. Active RN license in home state is required; position includes weekends, holidays, and evenings.