Remote Utilization Management Nurse Consultant

Santa Barbara Cottage Hospital

United States

Remote

USD 36,000 - 77,000

Full time

14 days+

Application generator

Stand out for this role — generate a tailored resume and cover letter in about a minute.

Get past ATS filters

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant to join our remote team. This 100% work-from-home role serves members across the CST zone, ensuring safe, appropriate care and timely approvals.

You will review clinical documents, collaborate with providers, and coordinate care while meeting state and federal requirements. Strong nursing background and hospital experience are essential for success.

Qualifications

Active, unrestricted RN license.
2+ years of acute hospital clinical experience.
Strong clinical assessment and decision-making abilities.
Excellent organizational skills with the ability to manage multiple priorities.
Ability to work independently and communicate effectively via phone.
Comfort with computer-based work and multitasking across screens.

Responsibilities

Reviewing services for medical necessity and benefit use and supporting discharge planning.
Applying clinical skills to assess, plan, implement, coordinate, monitor, and evaluate services.
Collecting and evaluating clinical information to make coverage determinations.
Communicating with providers and external partners to coordinate care.
Identifying opportunities for referrals to additional programs or services.
Promoting quality care delivery and effective benefit utilization.
Serving as a resource to stakeholders regarding UM processes.