Utilization Management Nurse Consultant
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Job Description
CVS Health Utilization Management Nurse Consultant reviewing clinical information and recommending coverage. Coordinating care and referrals to improve member healthcare outcomes remotely.
Responsibilities:
- Review clinical information and apply evidence-based criteria to make coverage recommendations
- Collaborate with providers and interdisciplinary teams to support member care
- Identify opportunities to improve healthcare quality, outcomes, and benefit utilization
- Coordinate referrals to additional programs and services that support member needs
- Serve as a clinical resource for internal and external stakeholders
- Support Utilization Management operations in a fast-paced, collaborative environment
- Combine patient advocacy, care coordination, and healthcare decision support to help members receive appropriate care
Requirements:
- Active, unrestricted RN license in your state of residence
- 2+ years of RN experience in adult acute care, critical care, medical-surgical, or specialty settings
- Strong clinical judgment, communication, and multitasking skills
- Ability to work efficiently across multiple computer systems in a productivity-driven environment
- Associate’s Degree in Nursing
- Residence in the Eastern Time Zone preferred
- Utilization Management or Managed Care experience preferred
- BSN preferred
- Ability to work evenings, weekends, and holidays as schedules may include them
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
- Must work within the state and city where currently living
- Ability to use multiple monitors and navigate multiple applications simultaneously
- Ability to use digital communication tools such as email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace tools
- Ability to log in to secure systems such as VPN and EHR portals
- Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
- Ability to troubleshoot common technical issues independently
- Openness to learning new skills as the workplace environment evolves
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- Remote work from home
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