Remote Utilization Nurse Consultant – Care Optimization

CVS Health Corporation

Northern (KY)

Remote

USD 44,000 - 94,000

Full time

2 days ago

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Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a Utilization Management Nurse Consultant to work remotely, normally 8a-5p EST, Monday to Friday, performing clinical assessments and coordinating care across members. The role involves evaluating services per guidelines, collaborating with providers, and identifying referral opportunities to improve care utilization.

The position supports a 24/7 UM operation with potential weekend/evening shifts and offers comprehensive benefits, including medical, dental, and

Qualifications

3+ years of experience as an acute care RN.
Active and unrestricted RN licensure in state of residence.
Able to work across multiple IT platforms/systems (EHR, VPN, etc.).
1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel).

Responsibilities

Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits.
Render coverage determinations/recommendations using clinical criteria and guidelines.
Communicate with providers and other parties to facilitate care and treatment.
Identify referral opportunities and opportunities to promote quality utilization of healthcare services.