Utilization Management Nurse Consultant

About This Role

The Utilization Management Nurse Consultant at CVS Health is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services for members. This role is ideal for experienced nurses looking to contribute to a collaborative healthcare environment.

Highlights

• Pay: $32 - $69/hour
• Location: Remote, CA
• Schedule: Full-time, includes weekends, holidays, and evening hours

What You'll Do

• Utilize clinical experience to assess and facilitate appropriate healthcare services.
• Gather clinical information and apply clinical criteria to render coverage determinations.
• 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.
• Perform close inspection of documents and navigate multiple systems.
• Adapt to a fast-paced changing environment while multitasking and prioritizing effectively.

Requirements

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

Benefits

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

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality while fostering a workplace where every colleague feels valued and belongs.