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 to support a 24/7 operation, including weekends, holidays and evenings. You will use clinical judgment to determine appropriate care and coordinate services for members.

The role requires 2+ years of adult acute/critical care experience, active RN licensure, and strong tech skills (Office 365, VPN/EHR access). Remote work from home options are available within state guidelines, with a 40-hour week.

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute care/critical care.
• Active current and unrestricted RN licensure in state of residence.
• Utilization Management is a 24/7 operation with weekends, holidays, and evenings.

Responsibilities

• Uses clinical judgement to render coverage determinations and coordinate care for members.
• Communicates with providers to facilitate care and identify referral opportunities.
• Collaborates in a fast-paced, results-driven utilization/benefit management function.
• Performs required documentation and maintains privacy and security guidelines.

Skills

RN licensure

Critical care experience

Communication skills

Education

Associate degree

BSN preferred

Tools

Microsoft Office 365

VPN / EHR portal

Multimonitor setup

Job description

CVS Health is seeking a Registered Nurse for Utilization Management to support a 24/7 operation, including weekends, holidays and evenings. You will use clinical judgment to determine appropriate care and coordinate services for members.

The role requires 2+ years of adult acute/critical care experience, active RN licensure, and strong tech skills (Office 365, VPN/EHR access). Remote work from home options are available within state guidelines, with a 40-hour week.