Utilization Management Nurse Consultant - Weekends (4-10 hour shifts)
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. Medicare Precertification Utilization Management Nurse Consultant (RN) Remote | Full-Time | Weekends Are you a detail-oriented RN passionate about improving healthcare outcomes? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time.
Requirements
- Active, unrestricted RN license in state of residence
- 3+ years of RN experience
- 1+ year Med/Surg experience
- Proficiency with Microsoft Office (Outlook, Teams, Excel)
- Willingness to work required schedule post-training
Nice To Haves
- Prior Authorization or Utilization Management experience
- Managed care experience
- MedCompass experience
- Ambulatory surgery background
- BSN preferred (Associate’s required)
Responsibilities
- Review and assess clinical information to support coverage determinations
- Apply clinical guidelines, policies, and sound judgment across the care continuum
- Collaborate with providers and care teams to coordinate treatment plans
- Identify opportunities to enhance quality, efficiency, and member outcomes
- Refer members to additional programs and services as appropriate
- Serve as a clinical resource within utilization/benefit management
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
