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Utilization Management Nurse Consultant at CVS Health - ApplyBlast

Utilization Management Nurse Consultant

CVS Health

3 days ago

3.2 on Glassdoor

Remote

Full Time

Medior

0 applicants

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About this role

The Utilization Management Nurse Consultant role involves reviewing clinical cases and making coverage determinations using evidence-based criteria to ensure members receive appropriate care. This full-time, remote position requires collaboration with providers and interdisciplinary teams to support treatment planning and improve quality outcomes. The role serves as a trusted clinical resource for internal and external stakeholders while applying clinical judgment to utilization management decisions.

Responsibilities

Review clinical cases and make coverage determinations using evidence-based criteria
Collaborate with providers and interdisciplinary care teams to support treatment planning
Apply clinical judgment to utilization management and prior authorization decisions

Skills

Qualifications

Active, unrestricted RN license in the state of residenceAssociate Degree in Nursing (ADN)

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.