Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; USD 44,000 - 95,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Bonus eligibility

Job summary

CVS Health is seeking a skilled Utilization Management RN to support our 24/7 operation. This role requires clinical assessment and coordination to facilitate appropriate healthcare services and benefits for members.

You will liaise with providers and teams to optimize care and utilization. The ideal candidate will have 2+ years of adult acute/critical care nursing, an active RN license, and experience with utilization management within a fast-paced environment.

Qualifications

• 2+ years RN experience in adult acute/critical care.
• Active, unrestricted RN license in state of residence.
• Utilization Management is a 24/7 operation with weekends/holidays/evening hours (approx. 12 weekends/year, 1 major and 1 minor holiday/year, 1 shift monthly).

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies guidelines, policy, and clinical judgment to render coverage determinations/recommendations.
• Communicates with providers and other parties to facilitate care and identify referral opportunities.
• Identifies opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
• Consults with internal and external stakeholders in the utilization/benefit management function.

Skills

Registered Nurse

Clinical assessment

Multitasking

Effective communication

Education

Associates Degree

BSN preferred

Tools

Office 365

EHR systems

VPN access

Job description

CVS Health is seeking a skilled Utilization Management RN to support our 24/7 operation. This role requires clinical assessment and coordination to facilitate appropriate healthcare services and benefits for members.

You will liaise with providers and teams to optimize care and utilization. The ideal candidate will have 2+ years of adult acute/critical care nursing, an active RN license, and experience with utilization management within a fast-paced environment.