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. 100% Remote | Nationwide We’re seeking a Utilization Management Nurse Consultant to join our high‑energy, collaborative team. In this fully remote role, you’ll apply your clinical expertise to ensure members receive the right care, at the right time, in the right setting—while meeting all regulatory and turnaround requirements. What You’ll Do: - Review clinical records to determine medical necessity and appropriate benefit utilization - Coordinate and document utilization and benefit management activities - Collaborate with providers and facilities to support safe, efficient discharge planning - Ensure compliance with federal and state turnaround time requirements - Communicate clearly and professionally with providers and internal partners - Supp...