Utilization Management Nurse Consultant

CVS Health•Work At Home-Kansas, KS

1d•$26 - $56•Remote

About The Position

CVS Health is seeking an experienced Registered Nurse to join its Utilization Management team in a remote role. The nurse reviews clinical information, applies evidence-based criteria, and collaborates with providers to help ensure members receive appropriate, high-quality healthcare services and benefits. The role operates in a remote office environment with productivity and quality performance expectations. Work-from-home colleagues must work from the state and city where they currently live and maintain a quiet, secure, private workspace that complies with CVS Health and HIPAA guidelines. A direct, hardwired internet connection meeting stated speed requirements is required; Wi-Fi and satellite internet are not permitted. CVS Health provides computer equipment and related devices, while the colleague provides workspace furniture. The position is a 40-hour-per-week, full-time role in a 24/7 operation, with schedules that may include evenings, weekends, and holidays. The typical pay range is $26.01–$56.14 per hour. The position is also eligible for a CVS Health bonus, commission, or short-term incentive program. Eligible colleagues receive a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

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.
Associate Degree in Nursing (ADN).
Strong communication, multitasking, and computer skills.
Ability to obtain or maintain a direct, hardwired internet connection to a modem/router within 7 feet of the computer, with at least 25 Mbps download and 3 Mbps upload speeds; Wi-Fi and satellite internet are not permitted.
A quiet, secure, private designated home work location, free from distractions and compliant with CVS Health and HIPAA guidelines.
Work from within the state and city where the colleague currently lives.
Provide 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 use digital communication channels, including email, calendar invitations, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 applications or similar applications such as Google Workspace.
Ability to access secure systems, follow basic computer and password security practices, and recognize suspicious emails or links.
Ability to troubleshoot common technical issues independently and contact IT for unresolved issues.
Openness to learning new skills as the workplace environment evolves.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Experience in Medical-Surgical nursing or a specialty clinical area.
Managed Care and/or Utilization Management experience.
Located in the Central Time Zone.

Responsibilities

Review and assess clinical information to support coverage determinations and care coordination.
Apply clinical guidelines, policies, and professional judgment to utilization management decisions.
Collaborate with providers and interdisciplinary teams to facilitate appropriate treatment and services.
Identify opportunities for care management referrals and member support programs.
Promote quality, cost-effective healthcare delivery and benefit utilization.
Provide utilization management expertise and support to internal and external stakeholders.