UM Nurse Consultant
About The Position
CVS Health is seeking an experienced Registered Nurse to join its Utilization Management team. The role uses evidence-based clinical review and care coordination to help ensure members receive appropriate care at the right time. The nurse reviews clinical information, applies guidelines and professional judgment, works with providers and healthcare teams, identifies care management and member support opportunities, and promotes effective utilization and quality improvement. This is a full-time work-from-home position requiring a suitable private home workspace, compliant direct-wired internet, and the ability to work within the state and city where the colleague lives. The company provides computer equipment, but the colleague supplies workspace furniture. The role involves using multiple applications, digital communication tools, secure systems, and standard office software.
Requirements
- Active, unrestricted RN license in the state of residence.
- At least 2 years of RN experience in an adult acute care or critical care setting.
- Strong communication, multitasking, and computer navigation skills.
- Ability to work a flexible schedule, including evenings, weekends, and holidays, as part of a 24/7 operation.
- Associate degree in Nursing.
- Ability to obtain and maintain a direct-wired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
- Maintain a quiet, secure, private, distraction-free home workspace compliant with CVS Health and HIPAA guidelines.
- Work within the state and city where the colleague currently lives.
- Provide personal workspace furniture, such as a desk or standing desk, and be able to work at a desk for extended periods.
- Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
- Ability to communicate using email, calendar invites, Teams messaging, and virtual meetings.
- Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
- Ability to access secure systems, follow basic computer and password security practices, and recognize suspicious emails or links.
- Ability to resolve common technical issues independently and contact IT when needed.
- Openness to learning new skills as the workplace evolves.
Nice To Haves
- At least 2 years of Med-Surg or specialty clinical experience.
- Managed Care and/or Utilization Management experience.
- Residence in a CST, MST, or PST location.
- Bachelor of Science in Nursing (BSN).
Responsibilities
- Review and assess clinical information to support coverage determinations and care recommendations.
- Apply clinical guidelines, policies, and professional judgment across the continuum of care.
- Collaborate with providers and healthcare teams to facilitate quality patient outcomes.
- Identify opportunities for care management referrals and member support programs.
- Promote effective healthcare utilization and quality improvement initiatives.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Eligibility for a CVS Health bonus, commission, or short-term incentive program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
