Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in United States, +48 more locations.

📋 Description

• Evaluate clinical cases and make coverage decisions based on evidence-based guidelines.

• Work in partnership with home care providers, attending physicians, and care teams to facilitate transitions from hospital and/or post-acute facilities to home care.

• Utilize clinical judgment to aid in utilization and benefit management decisions.

• Identify areas for enhancing care quality and improving member outcomes.

• Act as a clinical resource for both internal and external stakeholders.

⛳️ Requirements

• Current, unrestricted RN license in the state of residence.

• Minimum of 2 years of RN experience, with at least 1 year in Med/Surg.

• Excellent clinical assessment and decision-making abilities.

• Proficient in Microsoft Office applications (Outlook, Teams, Excel).

• Available to work Monday–Friday, 9:00 AM–6:00 PM in your respective time zone.

• Must be able to work during holidays and evening hours, as Utilization Management operates 24/7.

• Associate Degree in Nursing required.

• Experience in Utilization Management or Prior Authorization is preferred.

• Background in managed care is preferred.

• Experience in home health is preferred.

• BSN is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial wellness, based on eligibility.