Utilization Management Nurse Consultant
$54,101–$129,626 year
RemoteUnited States
Job Summary
Review clinical cases and make coverage determinations using evidence-based guidelines while collaborating with providers to coordinate appropriate treatment. Apply clinical judgment to support utilization and benefit management decisions, identifying opportunities to improve care quality and member outcomes. Serve as a clinical resource across internal and external stakeholders. This role requires an active, unrestricted RN license with 3+ years of experience, including 1+ year in Med/Surg, and an Associate Degree in Nursing. Candidates must work Monday–Friday, 9:00 AM–6:00 PM in their time zone, though Utilization Management is a 24/7 operation with schedules including holidays and evening hours. Transition your clinical skills into a collaborative, non-bedside role within CVS Health to simplify healthcare for individuals and communities.
Required Qualifications
- Active, unrestricted RN license in the state of residence
- 3+ years of RN experience
- 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–6:00pm PM in your time zone
- Associate Degree in Nursing
Desired Qualifications
- Utilization Management or Prior Authorization experience
- Managed care background
- Familiarity with MedCompass
- Ambulatory surgery experience
- BSN preferred
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