Utilization Management Nurse Consultant (Remote)

CVS Health Corporation; Illinois; Remote; USD 44,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs and other resources

Job summary

CVS Health is seeking a Utilization Management Nurse Consultant to leverage clinical expertise in assessing, planning, coordinating, and evaluating healthcare services for members. This role supports a collaborative healthcare environment and drives appropriate utilization of benefits.

The position offers full-time hours with remote work options in Illinois and standard business hours. Requires RN licensure, BSN preferred, and 2+ years in acute/critical care with experience in utilization

Qualifications

• Active RN licensure in good standing.
• BSN preferred; ADN acceptable with experience.
• 2+ years RN experience in adult acute/critical care.
• 3+ years in adult med-surg or specialty area preferred.

Responsibilities

• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care.
• Identify members for referral opportunities to integrate with other products and services.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization management.
• Monitor productivity and quality expectations and review documents.
• Multitask and prioritize effectively in a fast-paced environment.
• Navigate multiple systems and demonstrate proficiency in computer skills.
• Communicate effectively, both verbally and in writing.

Skills

RN licensure

Clinical nursing

Care coordination

Utilization management

Communication skills

Education

Associate or Bachelor of Science in Nursing (BSN preferred)

Job description

About This Role

The Utilization Management Nurse Consultant utilizes clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This role is ideal for those looking to contribute to a collaborative healthcare environment.

Highlights

• Pay: $32 - $69/hour
• Location: Remote, IL
• Schedule: Full-time, Standard business hours Monday-Friday 8:00am-5:00pm CST

What You'll Do

• Gather clinical information and apply clinical criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products and services.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization management.
• Perform close inspection of documents and monitor productivity and quality expectations.
• Multitask and prioritize effectively in a fast-paced environment.
• Navigate multiple systems and demonstrate proficiency in computer skills.
• Communicate effectively, both verbally and in writing.

Requirements

Education

• Associate or Bachelor of Science in Nursing (BSN preferred)

Experience

• 2+ years of clinical experience as a Registered Nurse in adult acute care/critical care setting
• 3+ years of clinical experience in adult 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 focus on building a world of health around every individual, prioritizing safety and quality in all operations.