The role involves reviewing clinical information and applying guidelines to make coverage determinations across the care continuum. The consultant collaborates with providers and internal teams to coordinate care and improve member outcomes.
Remote Healthcare Jobs (22)
Search = Nurse Consultant
Job category = Healthcare
The role involves reviewing and resolving clinical appeals by interpreting clinical records and applying regulatory criteria. It requires coordinating clinical resolutions with internal and external support for various appeal types including UM and Behavioral Health.
Utilization Management Nurse Consultant (UM) - Work at home in CST Zone
CVS Health
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Full Time
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13 hours ago
CVS Health
The UM Nurse Consultant coordinates and documents the utilization and benefit management process to ensure members receive appropriate care. Key duties include reviewing clinical documentation for medical necessity and collaborating with providers to support cost-effective healthcare delivery.
Utilization Management (UM) Nurse Consultant - Work at Home in CST Zone
CVS Health
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Full Time
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13 hours ago
CVS Health
The UM Nurse Consultant coordinates and documents the utilization and benefit management process to ensure members receive appropriate care. Key duties include reviewing clinical documentation for medical necessity and collaborating with providers to support cost-effective treatment plans.
Utilization Management (UM) Nurse Consultant - Work at Home in EST or CST Zone
CVS Health
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Full Time
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13 hours ago
CVS Health
The UM Nurse Consultant coordinates and documents the utilization and benefit management process to ensure members receive appropriate care. Key tasks include reviewing clinical documentation for medical necessity and collaborating with providers to support cost-effective healthcare delivery.
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Utilization Management (UM) Nurse Consultant - Work at Home in EST Zone
CVS Health
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Full Time
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14 hours ago
CVS Health
The role involves reviewing clinical documentation to determine medical necessity and appropriate benefit use for members. The consultant coordinates care plans and collaborates with providers to ensure high-quality, cost-effective healthcare delivery.
Utilization Management (UM) Nurse Consultant - Work at Home in EST Zone
CVS Health
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Full Time
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14 hours ago
CVS Health
The UM Nurse Consultant reviews clinical documentation to ensure members receive safe and appropriate care based on medical necessity. They collaborate with providers and facilities to coordinate treatment plans and facilitate efficient discharge planning.
Review clinical documentation to support coverage determinations and collaborate with providers to coordinate appropriate care. Identify opportunities to improve care quality and serve as a clinical resource for stakeholders.
Review clinical information and apply evidence-based criteria to precertification requests to ensure high-quality member care. Collaborate with providers and medical directors to authorize services and manage a high-volume workload.
Review clinical cases to make coverage determinations using evidence-based guidelines. Collaborate with providers and care teams to coordinate appropriate treatment and improve member outcomes.
Review clinical cases to make coverage determinations using evidence-based guidelines. Collaborate with providers and care teams to coordinate appropriate treatment and improve member outcomes.
Utilization Management Nurse Consultant - Medical Review (Remote)
CVS Health
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Full Time
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2 Days Ago
CVS Health
Perform clinical reviews of medical cases to determine medical necessity using evidence-based criteria and plan policies. Collaborate with providers and assist in training new nurse reviewers to ensure high-quality care management.
The role involves assessing and coordinating healthcare services for members by applying clinical criteria and guidelines to render coverage determinations. The consultant collaborates with providers to facilitate treatment and identifies opportunities to improve healthcare quality and benefit utilization.
Plans and manages internal projects to meet business objectives and state regulatory compliance for the Quality Management program. Links quality management activities to business goals through innovation and integration of data sources.
Utilization Management Nurse Consultant - Medical Review (Remote)
CVS Health
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Full Time
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1 Week Ago
CVS Health
Perform clinical reviews to ensure members receive timely and medically necessary care using evidence-based guidelines. Collaborate with providers and assist in training new nurse reviewers to enhance production and quality.
Utilization Management Nurse Consultant - Eastern Time Zone
CVS Health
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Full Time
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1 Week Ago
CVS Health
Coordinate and document all aspects of the utilization and benefit management program to ensure members receive appropriate care. Review clinical records to determine medical necessity and facilitate safe discharge planning.
Clinical Quality Nurse Consultant
Blue Cross and Blue Shield of Kansas
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Full Time
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1 Week Ago
Blue Cross and Blue Shield of Kansas
Acts as a clinical liaison to support quality improvement, care coordination, and value-based care initiatives between providers and members. Implements data-informed clinical processes and ensures compliance with regulatory and accreditation standards.
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Clinical Nurse Consultant- KY/WV
Bristol Myers Squibb
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Full Time
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2 Weeks Ago
Bristol Myers Squibb
The Clinical Nurse Consultant serves as a clinical expert providing education and support to healthcare professionals regarding BMS hematology and oncology products. They drive peer-to-peer interactions to optimize patient outcomes and manage the clinical landscape within a defined geography.
Clinical Nurse Consultant- Pennsylvania
Bristol Myers Squibb
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Full Time
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3 Weeks Ago
Bristol Myers Squibb
The Clinical Nurse Consultant serves as a clinical expert providing education to healthcare professionals on BMS hematology and oncology products to optimize patient outcomes. Responsibilities include developing professional relationships, delivering speaker programs, and providing infusion support for CAR T sites.
Clinical Nurse Consultant- Michigan
Bristol Myers Squibb
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Full Time
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3 Weeks Ago
Bristol Myers Squibb
The Clinical Nurse Consultant serves as a clinical expert providing education to healthcare professionals on hematology and oncology products to optimize patient outcomes. They develop professional relationships with academic and community providers and deliver clinical exchanges to clarify patient identification and management.
Clinical Nurse Consultant – Mid-Atlantic, Northeast, Midwest
ICU Medical
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Full Time
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9 Weeks Ago
ICU Medical
The Clinical Nurse Consultant provides training and consultation on ICU Medical's clinical products, software, and services. They lead clinical nursing efforts and collaborate with cross-functional teams to integrate infusion devices with EHR systems.
The role involves assessing and coordinating healthcare services for members by applying clinical criteria and guidelines to render coverage determinations. The consultant collaborates with providers to facilitate treatment and identifies opportunities to improve the quality and effectiveness of benefit utilization.
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