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
- 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.
- 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
- 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
- other resources, based on eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
