Remote Utilization Nurse Consultant: Care Optimization

IntelliResume; Indiana (PA); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant for a remote, full-time role. The position supports coverage determinations, care coordination, and patient outcomes with a strong clinical background in acute/critical care and managed care settings.

The role is based remotely in IN, offering a competitive hourly pay range and opportunities to connect patients with resources and programs that improve healthcare value and quality.

Qualifications

• Associate degree in nursing is required; BSN preferred.
• Minimum 2 years of adult acute or critical care nursing experience.
• Minimum 2 years of Med-Surg or specialty nursing; managed care or utilization management experience preferred.

Responsibilities

• Review clinical documentation and apply evidence-based criteria to support coverage determinations.
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care.
• Collaborate with providers and care teams to facilitate appropriate treatment plans and care coordination.
• Identify opportunities to improve healthcare quality, effectiveness, and benefit utilization.
• Connect members to additional programs and resources that support positive health outcomes.
• Serve as a clinical resource and consultant to internal and external stakeholders.

Skills

Clinical assessment

Evidence-based decision making

Education

Associate Degree in Nursing

BSN preferred

Job description

CVS Health is seeking an Utilization Management Nurse Consultant for a remote, full-time role. The position supports coverage determinations, care coordination, and patient outcomes with a strong clinical background in acute/critical care and managed care settings.

The role is based remotely in IN, offering a competitive hourly pay range and opportunities to connect patients with resources and programs that improve healthcare value and quality.