Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 40,000 - 86,000; Full time

Job summary

CVS Health is seeking a Registered Nurse for Utilization Management. You will assess and coordinate care, apply clinical criteria to determine coverage, and communicate with providers to support appropriate treatment.

The role requires collaboration across teams and a focus on quality and cost-effective care. Ideal candidates hold an Associate degree with BSN preferred, and have 2+ years RN experience in adult acute/critical care, with the ability to work a 24/7 schedule including weekends and

Qualifications

• 2+ years RN experience in adult acute/critical care.
• Active unrestricted RN license in residence state.
• Utilization Management requires flexible 24/7 schedule.

Responsibilities

• Assess, plan, implement and coordinate healthcare services for members.
• Apply clinical criteria and guidelines to determine coverage decisions.
• Communicate with providers to facilitate care and referrals.
• Promote quality and appropriate utilization of services.
• Collaborate with internal/external teams in utilization/benefits management.

Skills

RN clinical experience

Excellent communication

multitasking

Education

Associates Degree

BSN preferred

Tools

Microsoft Office 365

EHR systems

VPN/ security best practices

Job description

CVS Health is seeking a Registered Nurse for Utilization Management. You will assess and coordinate care, apply clinical criteria to determine coverage, and communicate with providers to support appropriate treatment.

The role requires collaboration across teams and a focus on quality and cost-effective care. Ideal candidates hold an Associate degree with BSN preferred, and have 2+ years RN experience in adult acute/critical care, with the ability to work a 24/7 schedule including weekends and