Utilization Management Nurse Consultant (Remote)

CVS Health Corporation; Kentucky; Remote; USD 40,000 - 85,000; 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 who applies clinical expertise to assess, plan, coordinate, monitor and evaluate healthcare services for members in a collaborative setting.

You will gather information, render coverage determinations, communicate with providers, identify referral opportunities, and support quality and efficiency of care. This full-time remote role requires an active RN license, 3+ years in adult acute/critical care, and BSN preferred.

Qualifications

• Active, current, and unrestricted RN licensure in the state of residence.
• 3+ years of clinical RN experience in hospital settings (adult acute/critical care).
• BSN preferred; ADN acceptable if applicable.

Responsibilities

• Gather clinical information and apply 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 with internal and external stakeholders in utilization management.
• Review documents carefully and monitor productivity and quality expectations.
• Multitask and prioritize effectively in a fast-paced environment.
• Navigate multiple systems and demonstrate proficiency with computer skills.
• Communicate effectively, both verbally and in writing.

Skills

Clinical nursing experience

Communication skills

Collaboration

Education

Associate or Bachelor of Science in Nursing (BSN preferred)

Tools

RN licensure in state of residence

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 nurses with strong clinical backgrounds looking to work in a collaborative environment.

Highlights

• Pay: $29 - $62/hour
• Location: Remote, OH
• Schedule: Full-time, Standard business hours Monday-Friday 8:00am-5:00pm EST

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.
• Navegate multiple systems and demonstrate proficiency with computer skills.
• Communicate effectively, both verbally and in writing.

Requirements

Education:

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

Experience:

• 3+ years of clinical experience as a Registered Nurse in a hospital setting in adult acute care/critical care

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, shaping a more connected and compassionate health experience.