Remote Utilization Management Nurse Consultant

CVS Health; Washington; Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Registered Nurse to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members. The role involves applying clinical criteria to determine coverage along the care continuum and communicating with providers to coordinate care.

Qualified candidates will hold an active RN license, have 2+ years of acute/critical care experience, and be available to work weekends, holidays, and evenings.

Qualifications

• Active RN license in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Must reside in Central, Mountain, or Pacific Time zones and be available weekends/holidays/evenings.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Apply clinical criteria/guidelines to render coverage determinations/recommendations along the care continuum.
• Communicate with providers to facilitate care and identify referral opportunities.
• Promote quality, effectiveness of healthcare services and benefit utilization.
• Lend clinical expertise to coordination and administration of utilization/benefit management.

Job description

CVS Health is seeking a Registered Nurse to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members. The role involves applying clinical criteria to determine coverage along the care continuum and communicating with providers to coordinate care.

Qualified candidates will hold an active RN license, have 2+ years of acute/critical care experience, and be available to work weekends, holidays, and evenings.