RN Utilization Management Consultant

CVS Health; Harrisburg (Dauphin County); On-site; USD 40,000 - 85,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse in Utilization Management to assess and coordinate care, determine coverage decisions, and collaborate with providers. The role requires an active RN license and 2+ years of acute or critical care experience, with a 24/7 schedule including evenings, weekends, and holidays.

Associates degree required; BSN preferred. This full-time position includes a comprehensive benefits package typical for CVS Health nationwide.

Qualifications

• 2+ years of RN experience in adult acute or critical care.
• Active, unrestricted RN licensure in the state of residence.
• Must work a 24/7 schedule including weekends, holidays, and evenings.

Responsibilities

• Assess, plan, implement, coordinate and evaluate options to facilitate appropriate healthcare services for members.
• Apply clinical criteria and guidelines to render coverage determinations.
• Communicate with providers and care teams to coordinate treatment and referrals.
• Identify opportunities to promote quality and efficiency in healthcare utilization.
• Collaborate with internal and external stakeholders in utilization management.

Skills

Registered Nurse

RN licensure in state

Utilization Management experience

Education

Associate's Degree

BSN preferred

Job description

CVS Health is seeking an experienced Registered Nurse in Utilization Management to assess and coordinate care, determine coverage decisions, and collaborate with providers. The role requires an active RN license and 2+ years of acute or critical care experience, with a 24/7 schedule including evenings, weekends, and holidays.

Associates degree required; BSN preferred. This full-time position includes a comprehensive benefits package typical for CVS Health nationwide.