Utilization Management Nurse Consultant

CVS Health

1d•$29 - $62•Remote

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 Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time. This is an exciting new role supporting home care requests for Florida Medicare members.

Requirements

Active, unrestricted RN license in the state of residence.
2+ years of RN experience, including 1+ year in Med/Surg
Strong clinical assessment and decision-making skills
Experience with Microsoft Office (Outlook, Teams, Excel)
Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
Associate Degree in Nursing

Nice To Haves

Utilization Management or Prior Authorization experience
Managed care background
Home health experience
BSN preferred

Responsibilities

Review clinical cases and make coverage determinations using evidence-based guidelines
Collaborate with home care providers, attending MDs and care teams to coordinate a smooth transition of care from a hospital and/or post-acute setting to home care
Apply clinical judgment to support utilization and benefit management decisions
Identify opportunities to improve care quality and member outcomes
Serve as a clinical resource across internal and external stakeholders