Remote Utilization Nurse Consultant (RN)

CVS Health Corporation; Oklahoma City (OK); Remote; USD 74,530,000 - 160,864,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement options

Wellness programs

Job summary

CVS Health Corporation in Oklahoma is seeking an Utilization Management Nurse Consultant (RN) to review medical necessity, coordinate care, support discharge planning, and make informed coverage recommendations in a remote, Oklahoma-based role.

You will work with providers and healthcare teams to ensure quality outcomes while meeting regulatory requirements, maintain HIPAA compliance, and contribute to efficient utilization management across the continuum of care.

Qualifications

• Active, unrestricted RN license in Oklahoma
• Minimum 2 years of acute care hospital RN experience
• Associate Degree in Nursing (BSN preferred)

Responsibilities

• Review clinical information and authorize services based on established criteria and guidelines
• Assess medical necessity and appropriate benefit utilization
• Coordinate care and support safe, efficient discharge planning
• Communicate with providers and healthcare teams to facilitate treatment plans
• Identify opportunities for care management and quality improvement
• Document and manage utilization review activities throughout the continuum of care

Skills

RN license

Acute care RN experience

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Office 365

EHR portal

Job description

CVS Health Corporation in Oklahoma is seeking an Utilization Management Nurse Consultant (RN) to review medical necessity, coordinate care, support discharge planning, and make informed coverage recommendations in a remote, Oklahoma-based role.

You will work with providers and healthcare teams to ensure quality outcomes while meeting regulatory requirements, maintain HIPAA compliance, and contribute to efficient utilization management across the continuum of care.