Utilization Management Nurse Consultant
About the role
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | 24/7 Operations Are you an experienced RN looking to transition from bedside care while continuing to make a meaningful impact on patient outcomes? Join our Utilization Management team and use your clinical expertise to help ensure members receive appropriate, high-quality, and cost-effective healthcare services.
- Apply your clinical expertise in a rewarding non-bedside nursing role
- Help improve healthcare quality and member outcomes
- Work remotely while collaborating with an experienced clinical team
- Build valuable experience in Utilization Management and Managed Care
Responsibilities
- Review clinical documentation and apply evidence-based criteria, policies, and clinical judgment to support coverage determinations
- Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
- Collaborate with providers and care teams to facilitate appropriate treatment plans and care coordination
- Ident