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. Utilization Management Nurse Consultant (RN) – Remote (U.S.) Make an impact from home while helping members receive the right care at the right time. We are seeking a Utilization Management Nurse Consultant (RN) to join a collaborative, high-energy team in a fully remote role. In this position, you will leverage your clinical expertise to review medical records, assess medical necessity, support discharge planning, and coordinate care to ensure members receive quality, cost-effective healthcare services.
Requirements
- Active, unrestricted RN license in the state of residence
- 2+ years of recent acute care hospital RN experience (within the past 10 years)
- Associate Degree in Nursing required
Nice To Haves
- Utilization Review experience
- Managed Care experience
- Strong telephonic communication skills
- BSN
- Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook)
Responsibilities
- Review clinical records to determine medical necessity and appropriate benefit utilization
- Coordinate and communicate utilization management activities with providers and facilities
- Support safe, timely, and effective discharge planning
- Ensure compliance with federal and state turnaround-time requirements
- Collaborate with interdisciplinary teams to meet complex member needs
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
