Remote Utilization Management Nurse Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

401(k) with company match

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management to support a 24/7 operation, including weekends, holidays, and evenings. You will assess, plan, and coordinate patient care and benefits, applying clinical criteria to determine coverage and guiding referrals to optimize outcomes.

The role requires active RN licensure, 2+ years in acute/critical care, and experience in utilization management is preferred. Hybrid work options may apply with comprehensive benefits.

Qualifications

• Must hold active RN licensure in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Experience in Utilization Management is preferred.

Responsibilities

• Assess, plan, implement, coordinate and monitor care to facilitate appropriate services/benefits.
• Apply clinical criteria and guidelines to render coverage determinations.
• Communicate with providers and members to coordinate care and referrals.
• Identify opportunities to promote quality and appropriate utilization of healthcare services.
• Collaborate with internal/external teams in utilization/benefit management.

Skills

RN licensure

Acute/critical care experience

Utilization Management experience

Communication skills

Education

Associates Degree

BSN preferred

Tools

Microsoft Office 365

EHR portal

VPN access

Job description

CVS Health is seeking a Registered Nurse for Utilization Management to support a 24/7 operation, including weekends, holidays, and evenings. You will assess, plan, and coordinate patient care and benefits, applying clinical criteria to determine coverage and guiding referrals to optimize outcomes.

The role requires active RN licensure, 2+ years in acute/critical care, and experience in utilization management is preferred. Hybrid work options may apply with comprehensive benefits.