Remote Utilization Management Nurse Consultant

CVS Health; Topeka (KS); Remoto; USD 36.000 - 77.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Descrizione del lavoro

CVS Health is seeking a Registered Nurse for Utilization Management. This remote, full-time role requires 2+ years in adult acute/critical care, an active RN license, and readiness for a 24/7 schedule including weekends and holidays.

You will assess, plan, implement, and coordinate care options, gather clinical data, and apply guidelines to determine coverage. Strong communication with providers is essential for care facilitation and referrals.

Competenze

• 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

Mansioni

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
• Communicate with providers and other parties to facilitate care/treatment; identifies members for referral opportunities
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Conoscenze

RN experience

Communication skills

Time management

Formazione

Associate Degree in Nursing

BSN preferred

Descrizione del lavoro

CVS Health is seeking a Registered Nurse for Utilization Management. This remote, full-time role requires 2+ years in adult acute/critical care, an active RN license, and readiness for a 24/7 schedule including weekends and holidays.

You will assess, plan, implement, and coordinate care options, gather clinical data, and apply guidelines to determine coverage. Strong communication with providers is essential for care facilitation and referrals.