Remote Utilization Management Nurse Consultant

4062 Aetna Resources, LLC; United States; Remote; USD 40,000 - 85,000; 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 is seeking a Utilization Management Nurse Consultant to assess, plan, and coordinate healthcare services for members. This role involves 24/7 coverage with weekend/evening hours and requires strong clinical judgment and cross-functional collaboration.

Critical skills include communicating with providers, applying guidelines, and promoting efficient benefit utilization. A BSN is preferred and home-based work setup is supported within the EST region.

Qualifications

• 3+ years of clinical experience as a Registered Nurse in a hospital setting (adult acute/critical care).
• Active, unrestricted RN licensure in state of residence.
• Utilization Management requires 24/7 coverage including weekends, holidays, and evenings.

Responsibilities

• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify referral opportunities to integrate with other products, services, or programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal/external stakeholders in utilization/benefit management.

Skills

Registered Nurse

Utilization Management

Clinical assessment

Communication skills

Education

BSN preferred

Tools

EHR systems

VPN/secure access

Microsoft Office 365

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to assess, plan, and coordinate healthcare services for members. This role involves 24/7 coverage with weekend/evening hours and requires strong clinical judgment and cross-functional collaboration.

Critical skills include communicating with providers, applying guidelines, and promoting efficient benefit utilization. A BSN is preferred and home-based work setup is supported within the EST region.