Utilization Management Nurse Consultant - Remote

Overview

As a Utilization Management Nurse Consultant at CVS Health, you will leverage your clinical experience to assess and coordinate healthcare services for members, ensuring appropriate care and benefits.

In Short

• Utilizes clinical skills to facilitate healthcare services for members.
• Gathers clinical information to support coverage determination.
• Communicates with providers and parties to facilitate care.
• Identifies opportunities for quality improvement in healthcare services.
• Consults with internal and external stakeholders on utilization management.
• Works in a typical office environment with productivity expectations.
• Requires effective communication and multitasking abilities.
• Position involves sedentary work with extended periods of sitting.
• Full-time schedule includes weekends, holidays, and evenings.
• Proficiency in computer skills is essential.

Requirements

• 2+ years as a Registered Nurse in acute care settings.
• Active RN licensure in state of residence required.
• Experience in managed care or Utilization Management preferred.
• Associate's Degree required; BSN preferred.
• Ability to adapt to a fast-paced environment.
• Strong verbal and written communication skills.
• Experience in med surg or specialty area is a plus.
• Willingness to work flexible hours as needed.
• Familiarity with clinical guidelines and criteria.
• Proficient in navigating multiple computer systems.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company matching contributions.
• Employee stock purchase plan.
• No-cost wellness programs and counseling services.
• Flexible work schedules and paid time off.
• Tuition assistance and dependent care resources.
• Retiree medical access and many other benefits.
• Commitment to employee wellness and support.
• Recognition programs and a strong workplace culture.
• Opportunities for professional growth and development.