Utilization Management Nurse Consultant - Remote

Overview

As a Utilization Management Nurse Consultant at CVS Health, you will be part of a dedicated team transforming health care by utilizing your clinical skills to coordinate and manage healthcare services effectively.

In Short

• 100% remote position from anywhere in the U.S.
• Work hours: 11:30am-8:00pm EST, Monday-Friday.
• Occasional weekend/holiday coverage required.
• Work in clinical telephone queue for prior authorization review.
• Utilize clinical skills to coordinate and document healthcare services.
• Gather clinical information to apply clinical criteria for recommendations.
• Communicate with providers to facilitate care and treatment.
• Identify opportunities for quality improvement in healthcare services.
• Requires a Registered Nurse license with multi-state privileges.
• 5 years of clinical experience required, including utilization management.

Requirements

• 5 years of varied clinical experience in acute care, home health, or long-term care.
• 1 year of utilization management experience in an inpatient/outpatient setting.
• Demonstrated ability to make independent clinical decisions.
• Registered Nurse with an unrestricted license in the state of residence.
• Must have residential broadband service with adequate internet speeds.
• Preferred: 1+ years of Managed Care experience.
• Preferred: Experience in a high-volume clinical call center environment.
• Preferred: Remote work experience.
• Education: Associate Degree in Nursing required, BSN preferred.
• Anticipated Weekly Hours: 40.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company matching contributions.
• Employee stock purchase plan.
• No-cost wellness programs and counseling services.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave resources.
• Retiree medical access and other benefits based on eligibility.