Remote Utilization Management Nurse Consultant

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

Job summary

CVS Health Corporation is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, CST-zone eligible, full-time position. You will coordinate, document, and communicate UM activities to ensure safe, appropriate care at the right time and setting.

The role requires an active RN license and 2+ years of acute hospital experience, with strong clinical judgment. Competitive hourly pay, benefits, and a collaborative team environment are offered in a remote CST-zone setting.

Qualifications

• Active RN license in good standing.
• 2+ years acute hospital clinical experience (medical-surgical, ICU, behavioral health or related).
• Strong clinical assessment and decision-making abilities.
• Excellent organizational skills with the ability to manage multiple priorities.
• Ability to work independently and communicate effectively by phone.
• Comfort with computer-based work across multiple screens and documenting while on calls.

Responsibilities

• Reviewing services for medical necessity and appropriate benefit use.
• Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits.
• Collecting and evaluating clinical information to make coverage determinations.
• Communicating with providers and external partners to coordinate care and treatment plans.
• Identifying opportunities for referrals to additional programs, services, or care solutions.
• Recognizing opportunities to promote quality care delivery and effective benefit utilization.
• Serving as a resource to internal and external stakeholders regarding UM processes and clinical considerations.

Skills

Active RN license

2+ years acute hospital experience

Clinical assessment

Organization skills

Independent work

Multitasking / Computer skills

Education

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office (Word, Excel, PowerPoint, Outlook)

Job description

CVS Health Corporation is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, CST-zone eligible, full-time position. You will coordinate, document, and communicate UM activities to ensure safe, appropriate care at the right time and setting.

The role requires an active RN license and 2+ years of acute hospital experience, with strong clinical judgment. Competitive hourly pay, benefits, and a collaborative team environment are offered in a remote CST-zone setting.