Remote Utilization Management Nurse Consultant

CVS Health

Yuma (AZ)

Remote

USD 36,000 - 86,000

Full time

6 days ago

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Benefits offered by this job

Medical

Dental

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for remote, full-time weekend coverage. You will review clinical information to support coverage determinations and collaborate with providers to coordinate care.

Ideal candidates have an active RN license, 3+ years RN and 1+ year Med/Surg experience, and proficiency with Office 365. The role includes weekend shifts, after training, with 24/7 operation and potential benefits.

Qualifications

Active, unrestricted RN license in the state of residence.
3+ years of RN experience.
1+ year Med/Surg experience.
Proficiency with Microsoft Office (Outlook, Teams, Excel).
Willingness to work required schedule post-training.

Responsibilities

Review and assess clinical information to support coverage determinations.
Apply clinical guidelines, policies, and sound judgment across the care continuum.
Collaborate with providers and care teams to coordinate treatment plans.
Identify opportunities to enhance quality, efficiency, and member outcomes.
Refer members to additional programs and services as appropriate.
Serve as a clinical resource within utilization/benefit management.