Cvs health

Actively Hiring

Others

NA, United States

Full-time

Role Overview

Review clinical documentation and apply evidence-based criteria, policies, and clinical judgment to support coverage determinations as a Utilization Management Nurse Consultant in a remote work environment.

About Cvs health

At CVS Health, we are building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience. We are committed to fostering a workplace where every colleague feels valued and belongs.

Key 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
Identify opportunities to improve healthcare quality, effectiveness, and benefit utilization
Connect members to additional programs and resources that support positive health outcomes
Serve as a clinical resource and consultant to internal and external stakeholders

Requirements & Eligibility

Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment, critical thinking, and communication skills
Ability to manage multiple priorities in a fast-paced, technology-driven environment
Proficiency navigating multiple computer systems
Associate Degree in Nursing required

Required Skills & Tech

NursingUtilization ManagementManaged CareCritical CareClinical AssessmentMicrosoft Office 365