Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to assess, plan and coordinate healthcare services for members. The role involves applying clinical criteria for coverage decisions, communicating with providers, and coordinating referrals.

Work is remote from the U.S. with a typical Monday–Friday schedule, but requires readiness for weekend/holiday/evening hours due to 24/7 operations. RN licensure is required and BSN preferred.

Qualifications

• 2+ years of clinical experience as a Registered Nurse in hospital adult acute/critical care.
• Active current and unrestricted RN licensure in state of residence.
• Utilization Management operates 24/7; schedules include weekends, holidays and evenings.

Responsibilities

• Gathers clinical information and applies criteria or guidelines to determine coverage decisions.
• Communicates with providers to facilitate care and treatment.
• Identifies referral opportunities to integrate with other CVS products, services, or programs.
• Promotes quality and effectiveness of healthcare services and benefit utilization.
• Lends expertise to coordination and administration of utilization/benefit management.

Skills

Clinical judgment

Communication skills

Multitasking

Education

BSN preferred

Tools

Microsoft Office 365

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to assess, plan and coordinate healthcare services for members. The role involves applying clinical criteria for coverage decisions, communicating with providers, and coordinating referrals.

Work is remote from the U.S. with a typical Monday–Friday schedule, but requires readiness for weekend/holiday/evening hours due to 24/7 operations. RN licensure is required and BSN preferred.