Remote Utilization Management Nurse Consultant (RN)

CVS Health Corporation; Virginia; Hybrid; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote precertification role. Preference is given to Virginia residents or candidates holding Virginia and Compact RN licenses.

The position involves reviewing clinical information, coordinating with providers, and making utilization decisions in a fast-paced, remote setting. 40 hours/week with standard business hours and occasional on-call coverage.

Qualifications

• Active, unrestricted COMPACT RN license in your state of residence.
• 3+ years of clinical nursing experience.
• Strong computer skills with the ability to navigate multiple systems.
• Ability to work Monday-Friday, 8:00 AM-5:00 PM, with occasional weekend/holiday on-call coverage.
• Associate's degree in Nursing required.

Responsibilities

• Review clinical information and authorization requests using evidence-based guidelines and established criteria
• Collaborate with healthcare providers to gather necessary documentation
• Approve services within scope or refer complex cases to a Medical Director
• Manage a high volume of cases in a fast-paced, phone and computer-based environment

Skills

Compact RN license

Clinical nursing experience

Computer skills

Scheduling ability

Associate's degree in Nursing

Education

Associate's degree in Nursing

BSN (preferred)

Tools

EHR systems

MS Office 365

Job description

CVS Health Corporation is seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote precertification role. Preference is given to Virginia residents or candidates holding Virginia and Compact RN licenses.

The position involves reviewing clinical information, coordinating with providers, and making utilization decisions in a fast-paced, remote setting. 40 hours/week with standard business hours and occasional on-call coverage.