Remote Utilization Management Nurse Consultant

CVS Health; United States; Remote; CAD 51,000 - 133,000; Full time

Job summary

CVS Health is seeking an RN for a weekend, full-time, work-from-home role. The position requires Saturday and Sunday coverage with multiple scheduling options to meet operations.

You will assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members. Responsibilities include determining coverage using clinical criteria, collaborating with providers, and promoting quality and efficient care.

Qualifications

• Registered Nurse with active license in residence
• Diploma RN acceptable; Associate degree or BSN preferred
• 3+ years experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute settings
• 1+ years of Utilization Management / Care Management experience

Responsibilities

• Render coverage determinations and recommendations using clinical criteria and guidelines
• Communicate with providers to facilitate care and treatment
• Identify referral opportunities to integrate with other products or services
• Identify opportunities to promote quality and effectiveness of healthcare services
• Meet productivity and quality expectations as set by UMNC

Skills

Verbal & Written Communication

Computer Skills

Multitasking

Extended Sitting/Phone/Typing

Education

RN licensure

Diploma RN acceptable

Associate or BSN preferred

3+ years RN experience

1+ years UM/CM experience

Job description

CVS Health is seeking an RN for a weekend, full-time, work-from-home role. The position requires Saturday and Sunday coverage with multiple scheduling options to meet operations.

You will assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits for members. Responsibilities include determining coverage using clinical criteria, collaborating with providers, and promoting quality and efficient care.