Utilization Management Nurse Consultant

CVS Health•New York, NY

1d•Remote

About The Position

CVS Health is building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience. The company is committed to fostering a workplace where colleagues are passionate, innovative, accountable, and prioritize safety and quality. This role is part of a mission to simplify health care one person, one family, and one community at a time. The Utilization Management Nurse Consultant (UMNC) is a motivated, detail-oriented individual sought to join a collaborative, fast-paced, fully remote team. In this role, the UMNC will leverage clinical expertise to ensure members receive appropriate care (right time, right setting) while supporting quality outcomes and efficient benefit utilization.

Requirements

Active, unrestricted RN license in the state where you reside
2+ years recent acute care hospital experience (within the past 10 years)
Strong computer skills, including Microsoft Word, Excel, and PowerPoint
Excellent written and verbal communication skills
Highly organized, detail-oriented, and comfortable multitasking

Nice To Haves

Utilization Review or Managed Care experience
Strong telephonic communication skills

Responsibilities

Review clinical records to determine medical necessity using established criteria and guidelines
Coordinate and communicate with providers, facilities, and internal partners to support safe, effective care
Facilitate efficient discharge planning and care transitions
Apply clinical judgment to coverage determinations across the continuum of care
Identify opportunities to improve quality, efficiency, and member outcomes
Meet standard productivity and quality expectations in a dynamic environment