Utilization Management Nurse Consultant
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. Utilization Management Nurse Consultant (RN) - Remote Must Reside in Oklahoma. Join a collaborative team dedicated to helping members receive the right care, at the right time, in the right setting. As a Utilization Management Nurse Consultant, you will use your clinical expertise to review medical necessity, coordinate care, support discharge planning, and make informed coverage recommendations. You'll work closely with providers, facilities, and internal partners to ensure quality outcomes while meeting regulatory requirements.
Requirements
- Active, unrestricted RN license in Oklahoma
- Minimum 2 years of acute care hospital RN experience
- Associate Degree in Nursing (BSN preferred)
- 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.
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- Systems Access & Security: 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.
- Troubleshooting & Support: 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.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Nice To Haves
- Utilization Review and/or Utilization Management experience
- Managed Care experience
- Strong communication and critical-thinking skills
- Proficiency with Microsoft Office and computer-based systems
- Ability to effectively manage multiple priorities in a fast-paced environment
Responsibilities
- Review clinical information and authorize services based on established criteria and guidelines
- Assess medical necessity and appropriate benefit utilization
- Coordinate care and support safe, efficient discharge planning
- Communicate with providers and healthcare teams to facilitate treatment plans
- Identify opportunities for care management and quality improvement
- Document and manage utilization review activities throughout the continuum of care
Benefits
- medical, dental, and 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
