About the role
CVS Health is hiring a remote Utilization Management Nurse Consultant who lives in Texas or Virginia and works Eastern or Central hours. You'll gather clinical information, apply criteria and guidelines, and render coverage determinations across the continuum of care. Utilization management is a 24/7 operation, so the schedule includes weekends, holidays, and evenings.
Responsibilities
- Gather clinical information and apply the right clinical criteria, policies, and judgment to make coverage determinations
- Communicate with providers and other parties to coordinate care and treatment
- Identify members who could be referred to other products, services, or programs
- Look for ways to improve quality and make benefit utilization more effective
- Advise internal and external partners on utilization and benefit management
- Meet productivity and quality expectations in a fast-paced, multi-system desk environment
Requirements
- Active, current, unrestricted RN license in your state of residence
- At least 2 years of RN experience in an adult acute care or critical care setting
- Must live in the Eastern or Central time zone
- Associate degree required; BSN preferred
- Managed care or utilization management experience preferred
- Willing to work a schedule that includes weekends, holidays, and evening hours
- Hardwired home internet of at least 50 Mbps down / 5 Mbps up (Wi-Fi and satellite are not permitted) and a quiet, private, HIPAA-compliant workspace
- Comfortable with Microsoft 365 or Google Workspace, multiple monitors, VPN, and virtual meeting tools
What we offer
- Company-provided computer, monitor, keyboard, and headset
- Comprehensive CVS Health benefits package (details shared during the application process)
- Fully remote work from your home state