Utilization Management Nurse Consultant; Remote, EST​/CST

The Utilization Management Nurse Consultant role at CVS Health involves utilizing clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This position is ideal for nurses with a strong background in acute care who are looking to work in a remote setting.

• Pay: $29.10 - $62.32/hour
• Location: Remote, OH
• Schedule: Full-time
• Residency: Must reside in the state and city where they have confirmed they currently live

• Utilize clinical experience to assess and coordinate healthcare services for members
• Gather clinical information to apply appropriate clinical criteria for coverage determination
• Communicate with providers to facilitate care and treatment
• Identify members for referral opportunities to integrate with other services
• Promote quality effectiveness of healthcare services and benefit utilization
• Consult with internal and external constituents on utilization management
• Navigate multiple systems and applications to streamline tasks
• Communicate via digital channels including email and virtual meetings
• Resolve common technical issues independently
• Maintain a quiet and secure home work environment compliant with CVS Health and HIPAA guidelines

Education:

• Associates Degree required, BSN preferred

Experience:

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
• 2+ years of clinical experience in med surg or specialty area preferred
• Managed Care experience preferred, especially in Utilization Management

Licenses &

Certifications:

• Active current and unrestricted RN licensure in state of residence required

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on building a connected, convenient, and compassionate health experience for individuals and communities.