Remote Utilization Management Nurse Consultant — UM Expert

CVS Health Corporation; Springfield (IL); Remote; USD 44,000 - 95,000; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off

Remote work

Job summary

CVS Health Corporation is seeking an experienced UM Nurse Consultant to work fully remote in the U.S. The role uses clinical expertise to assess and coordinate care, determine coverage, and liaise with providers to optimize member benefits.

Requirements include 3+ years acute care RN experience, active RN license, and proficiency with IT platforms and MS Office. Associates degree in nursing is required; BSN preferred.

Qualifications

• Active RN license without restrictions in state of residence.
• Minimum 3 years of acute care nursing experience.
• Ability to work across multiple IT platforms and electronic health records.
• Proficient with Microsoft Office applications (Outlook, Teams, Excel).
• BSN preferred may be considered in lieu of some clinical experience.

Responsibilities

• Assess, plan, implement and coordinate care to facilitate appropriate services and benefits.
• Gather clinical information and apply criteria to render coverage determinations or recommendations.
• Communicate with providers to coordinate care and treatment options.
• Identify referral opportunities to integrate with other products and programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external stakeholders on utilization/benefit management.

Skills

Acute care RN experience

RN licensure (active/unrestricted)

IT platforms proficiency

MS Office (Outlook/Teams/Excel)

Education

Associates Degree in Nursing

BSN preferred

Tools

EHR system

Job description

CVS Health Corporation is seeking an experienced UM Nurse Consultant to work fully remote in the U.S. The role uses clinical expertise to assess and coordinate care, determine coverage, and liaise with providers to optimize member benefits.

Requirements include 3+ years acute care RN experience, active RN license, and proficiency with IT platforms and MS Office. Associates degree in nursing is required; BSN preferred.