Utilization Management Nurse Consultant
About The Position
CVS Health is hiring a Registered Nurse for its remote Utilization Management team. The role applies nursing expertise to help ensure members receive appropriate, high-quality, and cost-effective healthcare services and supports positive patient outcomes. It is a computer-based position in a 24/7 operation, with productivity and quality expectations and frequent collaboration with providers, members, and interdisciplinary teams. The employee works from home in the state and city where they currently live. The home workspace must be quiet, secure, private, compliant with CVS Health and HIPAA guidelines, and allow uninterrupted work. A direct, hardwired internet connection to a modem or router within seven feet of the computer is required, with a minimum speed of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. CVS Health provides computer equipment such as a keyboard, monitor, computer, and headset. The employee provides workspace furniture and must be able to work at a desk for extended periods. The position is full-time, with 40 anticipated weekly hours. Schedules may include evenings, weekends, and holidays. The stated pay range is $26.01–$56.14, and the position is eligible for a CVS Health bonus, commission, or short-term incentive program. Eligible benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.
Requirements
- Active, unrestricted RN license in the state of residence.
- At least 2 years of adult acute care and/or critical care nursing experience.
- Associate Degree in Nursing.
- Strong clinical assessment, critical thinking, and communication skills.
- Ability to manage multiple priorities in a fast-paced, technology-driven environment.
- Proficiency navigating multiple computer systems.
- Ability to obtain and maintain a direct, hardwired 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 designated home workspace compliant with CVS Health and HIPAA guidelines, and work from the state and city where currently living.
- Ability to use multiple monitors and applications, digital communication tools, and secure systems such as VPNs and EHR portals; follow basic computer and information-security practices.
- Ability to troubleshoot common technical issues and contact IT for unresolved problems.
- Openness to learning new skills as the workplace evolves.
Nice To Haves
- At least 2 years of Med-Surg or specialty nursing experience.
- Managed Care or Utilization Management experience.
- Residence in the North Central Time Zone.
- BSN.
Responsibilities
- Review clinical documentation and apply evidence-based criteria, 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 plans and care coordination.
- Identify opportunities to improve healthcare quality, effectiveness, and benefit utilization.
- Connect members to additional programs and resources that support positive health outcomes.
- Serve as a clinical resource and consultant to internal and external stakeholders.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligibility for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
