CrawlJobs Logo

Utilization Management Nurse Consultant

https://www.cvshealth.com/ Logo

CVS Health

Location Icon

Location:
United States, Work at Home

Category Icon
Category:
Nursing

Job Type Icon

Contract Type:
Employment contract

Salary Icon

Salary:

29.10 - 62.32 USD / Hour

Job Description:

As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program and our plan sponsor(s). You would be responsible for ensuring the member is receiving the appropriate care, at the appropriate time, and at the appropriate location using designated criteria, while adhering to federal and state regulated turn-around times.

Job Responsibility:

  • Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
  • Ensure members receive appropriate care at appropriate time and location using designated criteria
  • Review written and electronic clinical records
  • Review services to assure medical necessity
  • Apply clinical expertise to assure appropriate benefit utilization
  • Facilitate safe and efficient discharge planning
  • Work closely with facilities and providers to meet complex needs of members

Requirements:

  • Must have active current and unrestricted RN license in state of residence
  • 3+ years of acute hospital clinical experience as an RN
  • Must be able to work Monday through Friday 8am to 5pm EST zone with occasional on-call weekend and holiday rotation per business needs
  • 1+ years of MS Office suites experience including Outlook and Excel
  • Associate's Degree in Nursing or Diploma RN required

Nice to have:

  • Utilization Review experience
  • Managed Care experience
  • Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues
  • Strong telephonic communication skills
  • BSN preferred
What we offer:
  • Affordable medical plan options
  • 401(k) plan with matching company contributions
  • Employee stock purchase plan
  • Wellness screenings
  • Tobacco cessation and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

Additional Information:

Job Posted:
October 04, 2025

Expiration:
October 11, 2025

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:
Welcome to CrawlJobs.com
Your Global Job Discovery Platform
At CrawlJobs.com, we simplify finding your next career opportunity by bringing job listings directly to you from all corners of the web. Using cutting-edge AI and web-crawling technologies, we gather and curate job offers from various sources across the globe, ensuring you have access to the most up-to-date job listings in one place.