Utilization Management Nurse Consultant - Remote

Overview

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

In Short

• Work in a 24/7 operation with varying schedules including weekends and holidays.
• Collaborate with providers to facilitate patient care.
• Gather clinical information to make coverage determinations.
• Identify opportunities to improve healthcare service quality.
• Consult with internal and external stakeholders on utilization management.
• Maintain productivity and quality expectations in a typical office environment.
• Proficient in navigating multiple computer systems.
• Communicate effectively both verbally and in writing.
• Requires multitasking and adaptability in a fast-paced environment.
• Must hold an active RN license in your state of residence.

Requirements

• 2+ years of experience as a Registered Nurse in acute care/critical care.
• Active and unrestricted RN licensure.
• Preferred 2+ years of clinical experience in med surg or specialty areas.
• Managed Care experience preferred, especially in Utilization Management.
• Associates Degree required; BSN preferred.
• Preference for candidates residing in EST zones.
• Ability to perform close inspections of documents.
• Experience in a role requiring effective communication skills.
• Ability to work in a sedentary position for extended periods.
• Experience in a fast-paced changing environment.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with matching contributions.
• No-cost wellness programs for all colleagues.
• Flexible work schedules and paid time off.
• Tuition assistance and dependent care resources.
• Confidential counseling and financial coaching.
• Retiree medical access and various additional benefits.
• Eligibility for bonuses and incentive programs.
• Commitment to employee wellness and work-life balance.
• Recognition programs and a supportive workplace culture.