Utilization Management Nurse Consultant - Remote

Overview

The Utilization Management Nurse Consultant position at CVS Health involves evaluating healthcare services for precertification and collaborating with healthcare providers to ensure high-quality care.

In Short

• 100% remote position.
• Monday–Friday schedule with variable shift times.
• Conduct clinical reviews for inpatient and outpatient services.
• Use critical thinking to evaluate healthcare needs.
• Collaborate with healthcare providers for information gathering.
• Maintain accurate documentation across multiple systems.
• Participate in on-call rotations as needed.
• Requires active RN license and relevant nursing experience.
• Training commitment for 3 weeks required.
• Competitive salary and benefits offered.

Requirements

• Active, unrestricted RN license.
• Minimum 5 years of nursing experience.
• 3 years of clinical experience in acute care settings.
• 1 year of Utilization Management experience.
• Strong decision-making and clinical judgment skills.
• Proficient in clinical documentation tools.
• Ability to work in a fast-paced environment.
• Must attend mandatory training with 100% participation.
• Preferred experience in a managed care organization.
• Education: Associate's degree in nursing required.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• No-cost wellness programs.
• Paid time off and flexible work schedules.
• Tuition assistance and financial coaching.
• Employee stock purchase plan.
• Confidential counseling services.
• Dependent care resources.
• Retiree medical access.
• Comprehensive benefits package.