Utilization Management Nurse Consultant - Work at Home EST / CST

About This Role

The Utilization Management Nurse Consultant role at CVS Health involves utilizing clinical experience to assess, plan, implement, and evaluate healthcare services for members. This position is ideal for nurses with a strong background in acute care and a passion for improving healthcare delivery.

Highlights

• Pay: $29 - $62/hour
• Location: Remote, TX
• Residency: Must reside in EST or CST
• Schedule: 24/7 operation, includes weekends, holidays, and evening hours

What You'll Do

• Utilize clinical experience to assess and coordinate healthcare services for members.
• Gather clinical information and apply appropriate criteria to render coverage determinations.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other services and programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in utilization management.
• Perform close inspection of documents and navigate multiple systems.
• Maintain productivity and quality expectations in a typical office environment.
• Adapt to a fast-paced changing environment while multitasking and prioritizing tasks.
• Ensure compliance with CVS Health and HIPAA guidelines in a work-from-home setting.

Requirements

Education

• Associate's 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

• Must have active current and unrestricted RN licensure in state of residence

Benefits

• Dental and vision coverage
• Wellness resources
• Employee discounts
• Access to certain voluntary benefits
• Additional benefits details provided during the application process

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on fostering a workplace where every colleague feels valued and that they belong, reflecting the diverse communities they serve.