Utilization Management Nurse Consultant - Medical Review - Remote

Overview

The Utilization Management Nurse Consultant at CVS Health will utilize clinical experience to implement and evaluate medical review cases, ensuring quality care and adherence to clinical guidelines.

In Short

• Work from home anywhere in the US.
• Schedule: Monday - Friday, 8am-5pm EST.
• Utilize clinical experience for medical review cases.
• Collaborate in a team environment.
• Implement process improvements and technology enhancements.
• Required to attend initial training classes.
• 3+ years of clinical experience required.
• 1+ year in Utilization Review Management preferred.
• Proficient use of clinical documentation systems.
• Competitive pay and benefits offered.

Requirements

• Active RN license required.
• 5 years of independent clinical decision-making experience.
• Experience with MCG Milliman or InterQual preferred.
• Associate degree required; BSN preferred.
• Must work independently without distractions.
• Ability to mentor new staff.
• Strong communication skills.
• Flexibility to cross-train in multiple case types.
• Ability to meet quality and metric expectations.
• Willingness to participate in ongoing training.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• No-cost wellness programs.
• Flexible work schedules.
• Tuition assistance available.
• Paid time off and family leave options.
• Retiree medical access.
• Confidential counseling and financial coaching.
• Employee stock purchase plan.
• Comprehensive benefits for physical, emotional, and financial wellness.