Utilization Management Nurse Consultant

CVS Health•Work At Home-Kansas, KS

5d•$26 - $56•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | Central Time Zone Preferred Are you an experienced Registered Nurse looking to expand your impact beyond direct patient care? Join our Utilization Management team and use your clinical expertise to help ensure members receive appropriate, high-quality, and cost-effective healthcare services.

Requirements

Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment, critical thinking, and communication skills
Ability to multitask and work effectively in a fast-paced environment
Proficiency navigating multiple computer systems and applications
Associate Degree in Nursing required
You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Nice To Haves

2+ years of Med-Surg or specialty nursing experience
Managed Care or Utilization Management experience
Residence in the Central Time Zone preferred
BSN preferred

Responsibilities

Review clinical information and apply evidence-based guidelines, policies, and clinical judgment to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment and care planning
Identify opportunities to improve quality of care, member outcomes, and healthcare utilization
Connect members with additional programs, services, and resources when appropriate
Serve as a clinical resource for internal and external stakeholders