RN Utilization & Quality Management Consultant

CVS Health; Saint Paul (MN); Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced registered nurse to assess, plan, and coordinate healthcare services for members. The role emphasizes collaboration with providers and internal teams to determine appropriate care and optimize benefit utilization.

The position requires an active RN license in the state of residence and a minimum of two years in adult acute or critical care settings. Weekend, holiday, and evening availability may be required to meet business needs.

Qualifications

• Active RN license in resident state.
• 2+ years of RN experience in adult acute/critical care.
• Available to work weekends, holidays, and evenings as required by business needs.

Responsibilities

• Assess, plan, implement, coordinate, monitor and evaluate care options for members.
• Gather clinical information and apply guidelines to render coverage determinations.
• Communicate with providers to facilitate care and referrals.
• Consult with internal and external stakeholders to support utilization management.
• Maintain accuracy in documentation and adherence to HIPAA guidelines.

Skills

Clinical assessment

Collaboration

Communication

Multitasking

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Tools

EHR systems

Microsoft Office 365

Job description

CVS Health is seeking an experienced registered nurse to assess, plan, and coordinate healthcare services for members. The role emphasizes collaboration with providers and internal teams to determine appropriate care and optimize benefit utilization.

The position requires an active RN license in the state of residence and a minimum of two years in adult acute or critical care settings. Weekend, holiday, and evening availability may be required to meet business needs.