Utilization Management Nurse Consultant

CVS Health; California; Remote; USD 56,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Utilization Management Nurse Consultant to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This role requires a skilled RN with experience in acute/critical care and utilization management, offering remote work in California and a full-time schedule, including weekends and evenings.

Ideal candidates have an Associate’s degree (BSN preferred) and at least 2 years in clinical roles; managed care experience is a plus.

Qualifications

• Associates Degree required; BSN preferred.
• 2+ years of RN experience in adult acute/critical care.
• 2+ years of clinical experience in med/surg or specialty area preferred.
• Managed Care experience preferred, especially in Utilization Management.

Responsibilities

• Assess and facilitate appropriate healthcare services.
• Gather clinical information and apply criteria for coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult with internal and external stakeholders on utilization management.
• Inspect documents and navigate multiple systems.
• Adapt to a fast-paced environment and multitask effectively.

Skills

RN experience

Clinical assessment

Provider communication

Education

Associate's Degree

BSN preferred

Job description

About This Role

The Utilization Management Nurse Consultant at CVS Health is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services for members. This role is ideal for experienced nurses looking to contribute to a collaborative healthcare environment.

Highlights

• Pay: $32 - $69/hour
• Location: Remote, CA
• Schedule: Full-time, includes weekends, holidays, and evening hours

What You'll Do

• Utilize clinical experience to assess and facilitate appropriate healthcare services.
• Gather clinical information and apply clinical criteria to render coverage determinations.
• Communicate with providers to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents on utilization management.
• Perform close inspection of documents and navigate multiple systems.
• Adapt to a fast-paced changing environment while multitasking and prioritizing effectively.

Requirements

Education

• Associates Degree required, BSN preferred

Experience

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
• 2+ years of clinical experience in med surg or specialty area preferred
• Managed Care experience preferred, especially in Utilization Management

Licenses & Certifications

• Active current and unrestricted RN licensure in state of residence required

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality while fostering a workplace where every colleague feels valued and belongs.