Remote Utilization Management RN Consultant

CVS Health; Montana; Hybrid; USD 36,000 - 94,000; Full time

Job summary

CVS Health is seeking a registered nurse to support utilization management from a remote home-based setting. You will assess and plan care, coordinate services, and collaborate with providers to optimize patient outcomes and benefit utilization.

The role requires an active RN license, 2+ years in acute/critical care, and availability for non-standard hours, with a strong emphasis on documentation, privacy, and multidisciplinary teamwork.

Qualifications

• Active RN licensure in state of residence.
• 2+ years of RN experience in adult acute/critical care.
• Must reside in Central Time, Mountain Time, or Pacific Time zones.
• Available to work weekends, holidays, and evenings as required.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Render coverage determinations and recommendations along the care continuum.
• Communicate with providers and facilitate care; identify referral opportunities.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents in utilization/benefit management.

Skills

Clinical assessment

Care coordination

Communication skills

Multitasking

EHR familiarity

HIPAA compliance

Education

Associate's degree in Nursing or Nursing Diploma

Tools

Microsoft Office 365

EHR systems

VPN access

Job description

CVS Health is seeking a registered nurse to support utilization management from a remote home-based setting. You will assess and plan care, coordinate services, and collaborate with providers to optimize patient outcomes and benefit utilization.

The role requires an active RN license, 2+ years in acute/critical care, and availability for non-standard hours, with a strong emphasis on documentation, privacy, and multidisciplinary teamwork.