Utilization Management Nurse Consultant
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 Remote | Utilization Management | Work from Home Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive appropriate, high-quality care while improving healthcare outcomes across the continuum of care.
Requirements
- Active, unrestricted RN license in your state of residence
- 2+ years of adult acute care and/or critical care nursing experience
- Strong clinical assessment, critical thinking, and communication skills
- Ability to navigate multiple systems and work efficiently in a fast-paced environment
- Associate Degree in Nursing required
Nice To Haves
- 2+ years of Med-Surg or specialty nursing experience
- Managed Care or Utilization Management experience
- Reside in the Pacific or Mountain Time Zone
- California RN License
- BSN preferred
Responsibilities
- Review clinical information and apply evidence-based criteria, policies, and clinical judgment to support coverage determinations
- Assess, coordinate, monitor, and evaluate healthcare services and benefits for members
- Collaborate with providers and care teams to facilitate appropriate treatment and care planning
- Identify opportunities to improve healthcare quality, effectiveness, and utilization
- Connect members with additional programs and services that support their overall health needs
- Serve as a clinical resource for internal and external stakeholders
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
