Utilization Management Nurse Consultant

Job description

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. Utilization Management Nurse Consultant (RN) – Fully Remote Remote | Full-Time | RN License Required We’re seeking a motivated, detail-oriented Utilization Management Nurse Consultant (UMNC) to join our collaborative, fast-paced team. In this fully remote role, you’ll use your clinical expertise to ensure members receive the right care, at the right time, in the right setting—while supporting quality outcomes and appropriate benefit utilization. What You’ll Do: - Review clinical records to determine medical necessity using established criteria and guidelines - Coordinate and communicate with providers, facilities, and internal partners to support safe, effective care - Facilitate efficient discharge planning and care transitions - Apply clinical j...