Remote Utilization Management RN Consultant

CVS Health; Columbus (OH); On-site; USD 61,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote role. You will apply clinical judgment to determine coverage, coordinate care, and collaborate with providers. The position schedules Tue-Sat 9:30am-6:00pm and may include evenings, weekends, and holidays.

The role requires 3+ years of Med/Surg RN experience, active RN license, and ability to work across multiple IT platforms. Strong knowledge of Medicare/Medicaid and managed care is preferred.

Qualifications

• Active and unrestricted RN licensure
• 3+ years of Med/Surg RN experience
• Able to work across multiple IT platforms
• Proficient in Microsoft Office (Outlook/Teams/Excel)
• Knowledge of Medicare/Medicaid
• Managed care experience
• Utilization Management experience

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies criteria/guideline to render coverage determinations.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies opportunities to refer members to integrate with other products, services and programs.
• Lends expertise to coordination and administration of the utilization/benefit management function.

Skills

RN licensure

Med/Surg experience

UM experience

MS Office proficiency

MS Office 365

Education

Associates Degree

BSN preferred

Tools

EHR systems

Microsoft Office 365

Job description

CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote role. You will apply clinical judgment to determine coverage, coordinate care, and collaborate with providers. The position schedules Tue-Sat 9:30am-6:00pm and may include evenings, weekends, and holidays.

The role requires 3+ years of Med/Surg RN experience, active RN license, and ability to work across multiple IT platforms. Strong knowledge of Medicare/Medicaid and managed care is preferred.