Utilization Management Nurse Consultant - Medical Review - Remote

Overview

As a Utilization Management Nurse Consultant at CVS Health, you will leverage your clinical expertise to implement, coordinate, monitor, and evaluate medical review cases, ensuring quality and compliance in a remote work environment.

In Short

• Remote position available from anywhere in the US.
• Full-time schedule: Monday - Friday, 8am - 5pm EST.
• Utilize clinical skills to render medical determinations.
• Collaborate with management for training new reviewers.
• Work independently to meet quality and metric expectations.
• Apply critical thinking and evidence-based clinical criteria.
• Participate in process improvements and technology enhancements.
• Required to attend training classes during the first 3 weeks.
• Occasional overtime may be required.
• Eligible for bonuses and incentives based on performance.

Requirements

• Active Registered Nurse license.
• 3+ years of clinical experience.
• 1+ year of Utilization Review Management experience.
• 5 years of demonstrated independent decision-making.
• Proficient in clinical documentation systems.
• Associate Degree required; BSN preferred.
• Must attend all initial training classes.
• Preferred experience with MCG Milliman or InterQual.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company matching contributions.
• No-cost wellness programs and counseling services.
• Paid time off and flexible work schedules.
• Tuition assistance and dependent care resources.
• Employee stock purchase plan available.
• Access to retiree medical benefits.
• Programs for financial coaching and wellness screenings.