Utilization Management Nurse Consultant

CVS Health•Work At Home-Maryland, MD

3d•$32 - $69•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Join a dynamic healthcare team where your clinical expertise helps ensure members receive the right care at the right time. We are seeking an experienced Registered Nurse (RN) to support our Utilization Management team. In this role, you will review clinical information, apply evidence-based criteria and clinical judgment, communicate with providers, and help coordinate effective, high-quality healthcare services for members.

Requirements

Active, unrestricted RN license in state of residence
2+ years of RN experience in adult acute care or critical care settings
Strong clinical assessment, communication, and computer skills
Ability to thrive in a fast-paced, highly collaborative environment
Associates Degree in Nursing

Nice To Haves

Med-Surg or specialty clinical experience
Managed Care and/or Utilization Management experience
Candidates residing in Eastern time zones preferred
BSN

Responsibilities

Review and assess clinical information to support utilization and coverage determinations
Collaborate with providers, care teams, and internal partners to facilitate appropriate treatment and care plans
Identify opportunities for care management referrals and member support programs
Promote quality, cost-effective healthcare outcomes
Serve as a clinical resource for utilization and benefit management activities