Utilization Management Nurse Consultant – Preference for Virginia Residents
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. Remote UM Nurse Consultant RN Precertification Nurse (Telework) Work from anywhere! We are seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote Precertification Nurse role. Preference is given to Virginia residents or candidates holding both Virginia and Compact RN licenses.
Requirements
- Active, unrestricted COMPACT RN license in your state of residence
- 3+ years of clinical nursing experience
- Strong computer skills with the ability to navigate multiple systems
- Ability to work Monday-Friday, 8:00 AM-5:00 PM, with occasional weekend/holiday on-call coverage.
- Associate's degree in Nursing required
- 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.
- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
- Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
- Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- 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.
- 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.
- Openness to learning new skills in the future as the workplace environment evolves.
Nice To Haves
- Prior authorization or utilization management experience
- Compact RN license
- BSN
Responsibilities
- Review clinical information and authorization requests using evidence-based guidelines and established criteria
- Collaborate with healthcare providers to gather necessary documentation
- Approve services within scope or refer complex cases to a Medical Director
- Manage a high volume of cases in a fast-paced, phone and computer-based environment
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
- CVS Health bonus, commission or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
