Remote Utilization Management Nurse Consultant

CVS Health; 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 savings options

Wellness programs

Job summary

CVS Health in the United States seeks a Utilization Management Nurse Consultant specializing in Medical Review. This fully remote role supports timely, medically necessary care through clinical review and collaboration with providers.

The position emphasizes precision, communication, and compassion in a fast-paced desk-based environment. The ideal candidate will have an RN license, 3+ years of clinical experience, and utilization review experience, with a 3-week mandatory training.

Qualifications

• Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges.
• Minimum 3 years of clinical experience.
• 5 years demonstrated to make thorough independent decisions using clinical judgement.
• 5 Years proficient use of equipment including phone and computer and clinical documentation systems.
• 1+ Year of Utilization Review Management and/or Medical Management experience.
• Commitment to attend a mandatory 3-week training with 100% participation.

Responsibilities

• Utilizes clinical experience to implement, coordinate, monitor and evaluate medical review cases.
• Applies clinical criteria and policy specifics to render medical determinations.
• Uses clinical practice guidelines to authorize procedures or initiate referrals.
• Mentors training for new nurse reviewers and vendors.
• Cross-trains to review multiple case types for a flexible workforce.
• Recommends and tests process improvements and technology enhancements.
• Works independently to meet quality and metric expectations.

Education

Associate’s degree in nursing

BSN preferred

Tools

Medical documentation systems

Phone

Computer

Job description

CVS Health in the United States seeks a Utilization Management Nurse Consultant specializing in Medical Review. This fully remote role supports timely, medically necessary care through clinical review and collaboration with providers.

The position emphasizes precision, communication, and compassion in a fast-paced desk-based environment. The ideal candidate will have an RN license, 3+ years of clinical experience, and utilization review experience, with a 3-week mandatory training.