Remote Utilization Nurse Consultant: Care Coordination

4062 Aetna Resources, LLC; Kansas; Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant for a 100% work‑from‑home role. This CST zone position is open to CST residents nationwide and requires an active RN license with 2+ years of acute hospital experience.

You will review medical necessity, coordinate care, and document decisions while collaborating with providers and facilities. Excellent organizational and communication skills are essential.

Qualifications

• Active, unrestricted RN license is required.
• 2+ years of acute hospital clinical experience (medical‑surgical, ICU, behavioral health or other specialty).
• Strong clinical assessment and decision‑making abilities.
• Excellent organizational skills with the ability to manage multiple priorities.

Responsibilities

• Review medical necessity and benefit use, coordinate discharge planning.
• Apply clinical skills to assess, plan, implement, coordinate, monitor and evaluate care.
• Collect and evaluate clinical information to make coverage determinations.
• Communicate with providers and external partners to coordinate care.
• Identify opportunities for referrals to programs, services, or care solutions.
• Promote quality care delivery and effective benefit utilization.
• Serve as a resource on UM processes and clinical considerations.

Skills

RN license

Clinical assessment

Decision-making

Multitasking

Phone communication

Independent work

Computer proficiency

Time management

Education

ADN

BSN preferred

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Job description

CVS Health is seeking a Utilization Management Nurse Consultant for a 100% work‑from‑home role. This CST zone position is open to CST residents nationwide and requires an active RN license with 2+ years of acute hospital experience.

You will review medical necessity, coordinate care, and document decisions while collaborating with providers and facilities. Excellent organizational and communication skills are essential.