Remote Utilization Management Nurse Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Wellness programs

Job summary

CVS Health Corporation is seeking an Utilization Management Nurse Consultant to apply clinical expertise in assessing and coordinating care, ensuring appropriate healthcare services for members. The role requires collaboration with providers and internal teams within a 24/7 utilization management framework, with weekend and evening hours.

The ideal candidate has 2+ years of RN experience in acute care or critical care, active RN licensure, and a willingness to work variable shifts.

Qualifications

• 2+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care setting.
• 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.

Responsibilities

• Gathers clinical information and applies criteria to render coverage determinations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to internal and external constituents in utilization/benefit management.
• Works in a typical office environment with productivity and quality expectations.

Skills

RN experience

Clinical judgment

Communication

Collaboration

Time management

EHR navigation

Education

Associate or BSN

Job description

CVS Health Corporation is seeking an Utilization Management Nurse Consultant to apply clinical expertise in assessing and coordinating care, ensuring appropriate healthcare services for members. The role requires collaboration with providers and internal teams within a 24/7 utilization management framework, with weekend and evening hours.

The ideal candidate has 2+ years of RN experience in acute care or critical care, active RN licensure, and a willingness to work variable shifts.