Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking an RN for Utilization Management in Central Time Zone. The role involves 24/7 operations with weekend/holiday/evening hours, monitoring and coordinating member care. Associates degree required; BSN preferred.

Responsibilities include assessing needs, applying criteria for coverage and collaborating with providers to optimize services and outcomes. Strong computer and communication skills are essential.

Qualifications

• RN licensure active and unrestricted in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Utilization Management is a 24/7 operation with weekends/holidays/evening hours.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply criteria/guideline to render coverage determinations/recommendations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products, services and programs.
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal/external constituents in coordinating utilization/benefit management.

Skills

RN licensure

Utilization Management

Microsoft Office 365

Education

Associate's Degree

BSN (preferred)

Tools

Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint)

Job description

CVS Health is seeking an RN for Utilization Management in Central Time Zone. The role involves 24/7 operations with weekend/holiday/evening hours, monitoring and coordinating member care. Associates degree required; BSN preferred.

Responsibilities include assessing needs, applying criteria for coverage and collaborating with providers to optimize services and outcomes. Strong computer and communication skills are essential.