Remote Utilization Management Nurse Consultant: Impact Care

CVS Health Corporation; Illinois; Remote; USD 44,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs and other resources

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to leverage clinical expertise in assessing, planning, coordinating, and evaluating healthcare services for members. This role supports a collaborative healthcare environment and drives appropriate utilization of benefits.

The position offers full-time hours with remote work options in Illinois and standard business hours. Requires RN licensure, BSN preferred, and 2+ years in acute/critical care with experience in utilization

Qualifications

• Active RN licensure in good standing.
• BSN preferred; ADN acceptable with experience.
• 2+ years RN experience in adult acute/critical care.
• 3+ years in adult med-surg or specialty area preferred.

Responsibilities

• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care.
• Identify members for referral opportunities to integrate with other products and services.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization management.
• Monitor productivity and quality expectations and review documents.
• Multitask and prioritize effectively in a fast-paced environment.
• Navigate multiple systems and demonstrate proficiency in computer skills.
• Communicate effectively, both verbally and in writing.

Skills

RN licensure

Clinical nursing

Care coordination

Utilization management

Communication skills

Education

Associate or Bachelor of Science in Nursing (BSN preferred)

Job description

CVS Health is seeking a Utilization Management Nurse Consultant to leverage clinical expertise in assessing, planning, coordinating, and evaluating healthcare services for members. This role supports a collaborative healthcare environment and drives appropriate utilization of benefits.

The position offers full-time hours with remote work options in Illinois and standard business hours. Requires RN licensure, BSN preferred, and 2+ years in acute/critical care with experience in utilization