RN Utilization & Quality Management Consultant

CVS Health; Guin (AL); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an RN for utilization management to assess, plan, and coordinate healthcare services for members. The role focuses on applying clinical judgment to determine appropriate coverage and treatment options, while collaborating with providers to optimize care.

The position requires an active RN license, 2+ years in adult acute/critical care, and the ability to work weekends and evenings as needed.

Qualifications

• Active and unrestricted RN license in the state of residence.
• At least 2 years of RN experience in adult acute or critical care.
• Ability to work weekends, holidays and evenings as required by business needs.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services for members.
• Render coverage determination or recommendation per clinical guidelines.
• Communicate with providers to facilitate care and treatment.
• Identify opportunities to coordinate with other CVS Health programs and services.

Skills

RN skills

Clinical assessment

Communication

Education

Associates Degree in Nursing

Bachelors Degree in Nursing

Tools

Microsoft Office

Job description

CVS Health is seeking an RN for utilization management to assess, plan, and coordinate healthcare services for members. The role focuses on applying clinical judgment to determine appropriate coverage and treatment options, while collaborating with providers to optimize care.

The position requires an active RN license, 2+ years in adult acute/critical care, and the ability to work weekends and evenings as needed.