Utilization Management Nurse Consultant (UM) - Work at Home CST Zone

IntelliResume; Kansas; Remote; USD 36,000 - 77,000; 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 for a fully remote position. You will review medical necessity, facilitate discharge planning, and collaborate with providers to support members with complex needs.

Qualifications include ADN required, BSN preferred, 2+ years acute hospital experience, UR/Managed Care experience, and an active RN license. The role involves coordinating care and applying clinical expertise to ensure safe, effective care and appropriate benefits

Qualifications

• 2+ years of acute hospital clinical experience (medical-surgical, ICU, behavioral health or other specialty).
• 1+ year of Utilization Review experience.
• 1+ year of Managed Care experience.
• Active, unrestricted RN license required.

Responsibilities

• Review services for medical necessity and appropriate benefit use.
• Facilitate efficient discharge planning.
• Collaborate with providers and facilities to support members with complex needs.
• Apply clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits.
• Collect and evaluate clinical information to make coverage determinations.
• Communicate with providers and external partners to coordinate care and treatment plans.
• Identify opportunities for referrals to additional programs, services, or care solutions.
• Promote quality care delivery and effective benefit utilization.

Education

Associate Degree in Nursing (ADN) required

Bachelor of Science in Nursing (BSN) preferred

Job description

About This Role

The Utilization Management (UM) Nurse Consultant role is a fully remote position ideal for experienced nurses looking to apply their clinical expertise in a supportive environment. This position focuses on ensuring members receive safe, effective, and appropriate care while meeting regulatory requirements.

Highlights

• Pay: $26.01 - $56.14/hour
• Location: Remote, KS
• Schedule: Full-time, Monday–Friday, 8:00 AM–5:00 PM CST, with occasional weekends and holidays required

What You'll Do

• Review services for medical necessity and appropriate benefit use
• Facilitate efficient discharge planning
• Collaborate with providers and facilities to support members with complex needs
• Apply clinical skills to assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits
• Collect and evaluate clinical information to make coverage determinations
• Communicate with providers and external partners to coordinate care and treatment plans
• Identify opportunities for referrals to additional programs, services, or care solutions
• Promote quality care delivery and effective benefit utilization
• Serve as a resource to internal and external stakeholders regarding UM processes and clinical considerations

Requirements

Education

• Associate Degree in Nursing (ADN) required
• Bachelor of Science in Nursing (BSN) preferred

Experience

• 2+ years of acute hospital clinical experience (strong preference for medical-surgical, ICU, behavioral health or other specialty area)
• 1+ year of Utilization Review experience preferred
• 1+ year of Managed Care experience preferred

Licenses & Certifications

• Active, unrestricted RN license required

Benefits

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

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 included.