Remote Weekend RN - Utilization Management Consultant

CVS Health; California City (CA); Remote; USD 36,000 - 86,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement options

Job summary

CVS Health is seeking a Remote Utilization Management Nurse Consultant (RN) to review and determine appropriate coverage, applying policies and clinical guidelines. The role collaborates with care teams to coordinate treatment and improve member outcomes in a 4-day weekend schedule following training.

Required are an active RN license in the resident state, 3+ years RN experience and 1+ year Med/Surg, plus MS Office proficiency.

Qualifications

• Active, unrestricted RN license in state of residence.
• 3+ years of RN experience and 1+ year Med/Surg.
• Proficiency with Microsoft Office (Outlook, Teams, Excel).
• Willingness to work required schedule post-training.

Responsibilities

• Review and assess clinical information to support coverage determinations.
• Apply clinical guidelines, policies, and sound judgment across the care continuum.
• Collaborate with providers and care teams to coordinate treatment plans.
• Identify opportunities to enhance quality, efficiency, and member outcomes.
• Refer members to additional programs and services as appropriate.
• Serve as a clinical resource within utilization/benefit management.

Skills

RN license

RN experience

Med/Surg experience

MS Office proficiency

Schedule flexibility

Education

Associate’s degree in Nursing

BSN preferred

Tools

Microsoft Office 365

Teams

Job description

CVS Health is seeking a Remote Utilization Management Nurse Consultant (RN) to review and determine appropriate coverage, applying policies and clinical guidelines. The role collaborates with care teams to coordinate treatment and improve member outcomes in a 4-day weekend schedule following training.

Required are an active RN license in the resident state, 3+ years RN experience and 1+ year Med/Surg, plus MS Office proficiency.