Remote Utilization Management Nurse Consultant

CVS Health; Williamstown (NJ); On-site; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking an experienced registered nurse to join our care coordination team in the EST region. You will assess, plan, implement and monitor healthcare services and benefits for members, using clinical criteria and judgment to support coverage decisions.

You will collaborate with providers and internal teams, identify referral opportunities, and promote efficient utilization and quality care. This full-time, onsite role requires strong communication, computer skills, and ability to

Qualifications

• Active RN license in the state of residence.
• Applicant must reside in EST time zone.
• 2+ years of RN experience in adult acute/critical care.
• Must be available for weekends, holidays, and evening hours as required.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate healthcare services for members.
• Render coverage determinations/recommendations using clinical guidelines and judgment.
• Communicate with providers to facilitate care and identify referral opportunities.
• Support utilization management and coordination with internal/external stakeholders.

Skills

Effective communication

Clinical nursing

RN nursing experience

Education

Associates Degree in Nursing

Bachelor's Degree in Nursing

Job description

CVS Health is seeking an experienced registered nurse to join our care coordination team in the EST region. You will assess, plan, implement and monitor healthcare services and benefits for members, using clinical criteria and judgment to support coverage decisions.

You will collaborate with providers and internal teams, identify referral opportunities, and promote efficient utilization and quality care. This full-time, onsite role requires strong communication, computer skills, and ability to