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10d ago Curated

Utilization Management Nurse Consultant - Florida

CVS Health
  • Utilization Review
  • Full-time
  • $70,000 – $90,000
  • License: Florida
  • 3+ years

Job description

The Utilization Management Nurse Consultant uses clinical judgment to review prior authorization requests for medical necessity using MCG criteria. This is a remote role requiring an active Florida RN license. Responsibilities include reviewing clinical documentation, applying criteria, and making coverage determinations. Requires 3+ years of acute care experience. BSN preferred. Salary range $70,000-$90,000.

Key responsibilities

  • Review prior authorization requests for medical necessity
  • Apply MCG criteria to clinical documentation
  • Make coverage determinations within established guidelines
  • Escalate complex cases to medical director as needed

What you bring

  • Active Florida RN license
  • 3+ years acute care experience
  • Knowledge of MCG or InterQual criteria
  • Strong clinical judgment and communication skills

Tags

RemoteFlorida RNUtilization ReviewMCG

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